Old Oaks Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

OLD OAKS DENTAL LLC

Practice address

9809 39TH Ave Ste 1
Pleasant Prairie, WI 53158-3733

Phone

(715) 573-3868

NPI assigned

Jun 20, 2022

Organization subpart

No

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

Authorized official

Name

Aaron Bushong, DDS

Title

Owner

Phone

(715) 573-3868

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1093446163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9809 39TH AVE STE 1",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531583733",
            "telephone_number": "715-573-3868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9809 39TH AVE STE 1",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531583733",
            "telephone_number": "715-573-3868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD OAKS DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "BUSHONG",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-573-3868",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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