Active NPI
Daniel R Kujak, D.D.S.
- General Practice Dentistry
- La Crosse, WI
National Provider Identifier
1083761191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5352-015
- Practice address
- 1200 Main St
La Crosse, WI 54601-4102 - Phone
- (608) 784-4063
- Fax
- (608) 782-5757
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5352-015 | WI | Primary |
Addresses
Primary practice location
1200 Main St
La Crosse, WI 54601-4102
Mailing address
1200 Main St
La Crosse, WI 54601-4102
Phone (608) 784-4063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 391191322 | Other | WI | FED TAX ID |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | kujakdental@gmail.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160224001881 | WI | Order and Referring Only - Other (Non-Physician) | 1759686041 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610668800000",
"number": "1083761191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 MAIN ST",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546014102",
"telephone_number": "608-784-4063",
"fax_number": "608-782-5757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 MAIN ST",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546014102",
"telephone_number": "608-784-4063",
"fax_number": "608-782-5757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUJAK",
"first_name": "DANIEL",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2021-01-15",
"certification_date": "2021-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "5352-015",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED TAX ID",
"identifier": "391191322",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "kujakdental@gmail.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1200 Main St",
"city": "LA Crosse",
"state": "WI",
"country_code": "US",
"postal_code": "546014468",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.