Brandon J Valgardson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6502-15 Issued in WI

Practice address

880 Herriott Drive
Mauston, WI 53948

Phone

(920) 787-5514

Fax

(920) 787-4737

NPI assigned

Jun 8, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• La Clinica de Los Campesinos, Inc

  • Pharmacy
  • Wautoma, WI
  • NPI 1174322846
  NPD (past)
• La Clinica de Los Campesinos, Inc

  dba Noble Community Clinics

  • Federally Qualified Health Center (FQHC)
  • Stevens Point, WI
  • NPI 1790786929
  NPD (past)

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

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275955200000",
    "number": "1083934418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1440",
            "address_2": "400 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549821440",
            "telephone_number": "920-787-5514",
            "fax_number": "920-787-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 HERRIOTT DRIVE",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "53948",
            "telephone_number": "920-787-5514",
            "fax_number": "920-787-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALGARDSON",
        "first_name": "BRANDON",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-08",
        "last_updated": "2010-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6502-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Adair Thompson, RHD
• Emma Thonn
• Matthew Koehler Tourdot, PHARMD
• Nera G Tracy, RN
• Iam Pool Valdez Espinoza
• Nancy Ruth Vandeweghe, PA
• Jared Vesperman, PT
• Laura Kay Schwab Vinopal, M.S.
• Brooke Marie Von Arx, PA
• Jodi Lorene Waddell

• General Practice Dentistry in Mauston, WI
• Providers in Mauston, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; 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.