NPIMap

Organization Active NPI

Wauwatosa Dental Group SC

  • Dentist
  • Wauwatosa, WI
National Provider Identifier
1104885482
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
WAUWATOSA DENTAL GROUP SC
Practice address
2600 N Mayfair Rd
Suite 750
Wauwatosa, WI 53226-1309
Phone
(414) 257-3366
Fax
(414) 258-1390
NPI assigned
Mar 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
John M Dickinson, DDS
Title
President Owner
Phone
(414) 257-3366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2600 N Mayfair Rd
Suite 750
Wauwatosa, WI 53226-1309

Mailing address

2600 N Mayfair Rd
Suite 750
Wauwatosa, WI 53226-1309
Phone (414) 257-3366

National Provider Directory

National Provider Directory

Locations

2600 N Mayfair Rd
Ste 750
Wauwatosa, WI 53226
Phone (414) 253-1669

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104885482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD",
            "address_2": "SUITE 750",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261309",
            "telephone_number": "414-257-3366",
            "fax_number": "414-258-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD",
            "address_2": "SUITE 750",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261309",
            "telephone_number": "414-257-3366",
            "fax_number": "414-258-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUWATOSA DENTAL GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICKINSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "414-257-3366",
        "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": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.