Individual provider Active NPI

Todd A Stahnke, D.D.S.

  • General Practice Dentistry
  • Black Earth, WI
National Provider Identifier
1124007844
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4759-015 Issued in WI
Practice address
1209 Mills St
Black Earth, WI 53515-9420
Phone
(608) 767-3604
Fax
(608) 767-3606
NPI assigned
Jan 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4759-015 WI Primary

Addresses

Primary practice location

1209 Mills St
Black Earth, WI 53515-9420

Mailing address

1250 Prairie St
Prairie Du Sac, WI 53578-2041
Phone (608) 643-8505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4759-015WIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Village Family Dental Assocs. General Practice Past Accepting new patients
Village Family Dental Asscociates General Practice Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1124007844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 PRAIRIE ST",
            "city": "PRAIRIE DU SAC",
            "state": "WI",
            "postal_code": "535782041",
            "telephone_number": "608-643-8505",
            "fax_number": "608-643-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 MILLS ST",
            "city": "BLACK EARTH",
            "state": "WI",
            "postal_code": "535159420",
            "telephone_number": "608-767-3604",
            "fax_number": "608-767-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAHNKE",
        "first_name": "TODD",
        "middle_name": "A",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4759-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black Earth, WI

Sources for this page

Verify at the official NPI Registry.