NPIMap

Organization Active NPI

Delta Dental of Wisconsin Foundation Inc

  • Dental Clinic/Center
  • Stevens Point, WI
National Provider Identifier
1134898786
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DELTA DENTAL OF WISCONSIN FOUNDATION INC
Practice address
941 Michigan Ave
Stevens Point, WI 54481
Phone
(715) 204-1180
Fax
(715) 204-3901
NPI assigned
Sep 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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

Authorized official

Name
Ann Boson
Title
Executive Director
Phone
(715) 343-7209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

941 Michigan Ave
Stevens Point, WI 54481

Mailing address

PO Box 828
Stevens Point, WI 54481-0828

Other identifiers 3

IdentifierTypeStateIssuer
5495-015OtherWISTATE LICENSE
1002597-16OtherWISTATE LICENSE
1002005-15OtherWISTATE LICENSE

Other names 1

  • Smile Club Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1631059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1134898786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 828",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544810828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 MICHIGAN AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "54481",
            "telephone_number": "715-204-1180",
            "fax_number": "715-204-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA DENTAL OF WISCONSIN FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-08",
        "last_updated": "2021-09-08",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "BOSON",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-343-7209"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5495-015",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1002597-16",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1002005-15",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stevens Point, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.