NPIMap

Organization Active NPI

LTC Dental

  • Dental Clinic/Center
  • St Francis, WI
National Provider Identifier
1124619556
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
LTC DENTAL
Doing business as
LTC Dental
Practice address
4060 S Lake Dr Apt 4
Saint Francis, WI 53235-5256
Phone
(407) 375-3003
Fax
(800) 863-5373
NPI assigned
Jan 28, 2021
Last updated
Jan 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

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

Authorized official

Name
Ms. Tara RobinsonNPI 1609478585
Title
Owner
Phone
(407) 375-3003

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

4060 S Lake Dr Apt 4
Saint Francis, WI 53235-5256

Mailing address

4060 S Lake Dr Apt 4
Saint Francis, WI 53235-5256
Phone (407) 375-3003

Other names 1

  • LTC Dental Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL tara@ltc-dental.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1124619556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 S LAKE DR APT 4",
            "city": "SAINT FRANCIS",
            "state": "WI",
            "postal_code": "532355256",
            "telephone_number": "407-375-3003",
            "fax_number": "800-863-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 S LAKE DR APT 4",
            "city": "SAINT FRANCIS",
            "state": "WI",
            "postal_code": "532355256",
            "telephone_number": "407-375-3003",
            "fax_number": "800-863-5373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-375-3003",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "tara@ltc-dental.com",
            "affiliation": "N",
            "endpointDescription": "LTC Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "tara@ltc-dental.com",
            "address_1": "4060 S Lake Dr Apt 4",
            "city": "Saint Francis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532355256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "LTC Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Francis, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; 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.