NPIMap

Organization Active NPI

Outreach 4 Healthy Teeth, LLC

  • Dental Clinic/Center
  • Racine, WI
National Provider Identifier
1083254064
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
OUTREACH 4 HEALTHY TEETH, LLC
Practice address
500 College Ave
Racine, WI 53403-1058
Phone
(262) 620-6997
NPI assigned
Jan 8, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Michelle Fox, RDHNPI 1760799076
Title
Owner/Dental Hygienist
Phone
(262) 620-6997

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

500 College Ave
Racine, WI 53403-1058

Mailing address

500 College Ave
Racine, WI 53403-1058
Phone (262) 620-6997

Other practice location 1

9220 66th St
Kenosha, WI 53142-8234
Phone (262) 620-6997

National Provider Directory

National Provider Directory

Locations

500 College Ave
Racine, WI 53403
Phone (262) 620-6997

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1083254064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 COLLEGE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031058",
            "telephone_number": "262-620-6997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 COLLEGE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031058",
            "telephone_number": "262-620-6997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9220 66th St",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531428234",
            "country_code": "US",
            "telephone_number": "262-620-6997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OUTREACH 4 HEALTHY TEETH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-08",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/DENTAL HYGIENIST",
        "authorized_official_telephone_number": "262-620-6997",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.