NPIMap

Organization Active NPI

Oak Ridge Dental Clinic,SC

  • General Practice Dentistry
  • Watertown, WI
National Provider Identifier
1104950336
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4872 Issued in WI
Legal business name
OAK RIDGE DENTAL CLINIC,SC
Doing business as
Associated Dentists of Watertown
Practice address
101 Oakridge Court
Suite C
Watertown, WI 53094-4100
Phone
(920) 261-5400
Fax
(920) 261-1590
NPI assigned
Mar 16, 2007
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
Michael J Wertz, D.D.S.NPI 1265514335
Title
Owner
Phone
(920) 261-5400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 4872 WI Primary

Addresses

Primary practice location

101 Oakridge Court
Suite C
Watertown, WI 53094-4100

Mailing address

101 Oakridge Court
Suite C
Watertown, WI 53094-4100
Phone (920) 261-5400

Other identifiers 2

IdentifierTypeStateIssuer
33741400MedicaidWI
33354400MedicaidWI

Other names 1

  • Associated Dentists of Watertown Doing business as

National Provider Directory

National Provider Directory

Locations

101 Oakridge Ct
Ste C
Watertown, WI 53094
Phone (920) 261-5400

Practitioners & affiliated clinicians

Practitioners 5

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": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104950336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 OAKRIDGE COURT",
            "address_2": "SUITE C",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530944100",
            "telephone_number": "920-261-5400",
            "fax_number": "920-261-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 OAKRIDGE COURT",
            "address_2": "SUITE C",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530944100",
            "telephone_number": "920-261-5400",
            "fax_number": "920-261-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK RIDGE DENTAL CLINIC,SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WERTZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-261-5400",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33741400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33354400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Associated Dentists of Watertown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watertown, 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.