Active NPI
Drew J, Delforge, DDS
- General Practice Dentistry
- Monroe, WI
National Provider Identifier
1114102076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4145
- Practice address
- 2727 6TH Street
Lower Level
Monroe, WI 53566-0399 - Phone
- (608) 325-4995
- NPI assigned
- Jan 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4145 | WI | Primary |
Addresses
Primary practice location
2727 6TH Street
Lower Level
Monroe, WI 53566-0399
Mailing address
2727 6TH Street
P.O. Box 399
Monroe, WI 53566-0399
Phone (608) 325-4995
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33659800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4145 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393372800000",
"number": "1114102076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2727 6TH STREET",
"address_2": "P.O. BOX 399",
"city": "MONROE",
"state": "WI",
"postal_code": "535660399",
"telephone_number": "608-325-4995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2727 6TH STREET",
"address_2": "LOWER LEVEL",
"city": "MONROE",
"state": "WI",
"postal_code": "535660399",
"telephone_number": "608-325-4995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELFORGE",
"first_name": "DREW",
"middle_name": "J,",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-09",
"last_updated": "2014-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "4145",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33659800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.