Merit Dental of Connecticut PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MERIT DENTAL OF CONNECTICUT PC

Practice address

680 Hehli Way
Mondovi, WI 54755-1639

Phone

(715) 926-5050

Fax

(715) 926-4269

NPI assigned

Sep 17, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Moos, DDS

Title

PC Owner

Phone

(715) 926-5050

Specialties & licenses 1

Addresses

Other names 1

• Mondovi Dental Doing business as

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1104295302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 HEHLI WAY",
            "city": "MONDOVI",
            "state": "WI",
            "postal_code": "547551639",
            "telephone_number": "715-926-5050",
            "fax_number": "715-926-4269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 HEHLI WAY",
            "city": "MONDOVI",
            "state": "WI",
            "postal_code": "547551639",
            "telephone_number": "715-926-5050",
            "fax_number": "715-926-4269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIT DENTAL OF CONNECTICUT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-17",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "MOOS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PC OWNER",
        "authorized_official_telephone_number": "715-926-5050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mondovi Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Lee Jurgensen
• Jacob Jurgensen
• Jennifer L Kronenberg, MSW, LCSW
• Douglas R Lochner-Wright, PT
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.
• Merit Dental of Massachusetts PC
• Richard Mestelle
• Midwest Dental Care, Mondovi, Inc.
• Midwest Dental Care, Sheboygan, Inc.
• Midwest Dental Management

• Dentist in Mondovi, WI
• Providers in Mondovi, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; 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.