MDC Castle Rock

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MDC CASTLE ROCK

Doing business as

Castle Rock Dental

Practice address

205 Division St
Mauston, WI 53948-2109

Phone

(608) 847-5572

NPI assigned

Jun 24, 2019

Organization subpart

No

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

Authorized official

Name

Bernard Bolka

Title

Cfo

Phone

(920) 579-3188

Specialties & licenses 1

Addresses

Other names 1

• Castle Rock Dental Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1124689914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1658",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549361658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 DIVISION ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539482109",
            "telephone_number": "608-847-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDC CASTLE ROCK",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "BOLKA",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-579-3188"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Mauston",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "205 Division St",
            "city": "Mauston",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539482109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Castle Rock Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patrick Michael McCormick, DDS
• Collin Robert McCulloch, DC
• Robert James McGlew, RPH
• Meghan McInnis, DPT
• Mary Kay McLean, M.S.,CCC-A
• MDC Mauston SC (Castle Rock Dental)
• Andressa Medrado-Corey, MD
• Edward A Merz, LPC
• Mile Bluff Medical Center Inc (Fair View Nursing Home)
• Mile Bluff Medical Center Inc (Mile Bluff Urgent Care)

• Dental Clinic/Center in Mauston, WI
• Providers in Mauston, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; 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.