NPIMap

Organization Active NPI

Wisconsin Dental Group, S.C.

Doing business as ForwardDental Brookfield

  • General Practice Dentistry
  • Brookfield, WI
National Provider Identifier
1104574623
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Doing business as
ForwardDental Brookfield
Practice address
15680 W Capitol Dr
Brookfield, WI 53005-2221
Phone
(262) 373-0344
NPI assigned
Mar 14, 2022
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WISCONSIN DENTAL GROUP, S.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

15680 W Capitol Dr
Brookfield, WI 53005-2221

Mailing address

15680 W Capitol Dr
Brookfield, WI 53005-2221
Phone (262) 373-0344

Other names 1

  • ForwardDental Brookfield Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wi DTL GRP-HLS CRNS32 organizations share this tax ID, including this one
Part of
Wi DTL GRP-HLS CRNS

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

15680 W Capitol Dr
Brookfield, WI 53005
Phone (262) 373-0344

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1104574623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15680 W CAPITOL DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052221",
            "telephone_number": "262-373-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15680 W CAPITOL DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052221",
            "telephone_number": "262-373-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN DENTAL GROUP, S.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WISCONSIN DENTAL GROUP, S.C.",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForwardDental Brookfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.