Active NPI
Mark R Zelko, D.D.S.
- General Practice Dentistry
- Pewaukee, WI
National Provider Identifier
1144603671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1001162-15
- Practice address
- 2305 Silvernail Rd
Pewaukee, WI 53072-5402 - Phone
- (262) 548-0770
- NPI assigned
- Jul 1, 2015
- Sex
- Male
- Sole proprietor
- No
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 | 1001162-15 | WI | Primary |
Addresses
Primary practice location
2305 Silvernail Rd
Pewaukee, WI 53072-5402
Mailing address
W236S4630 Whispering Hills CT
Waukesha, WI 53189-9774
Phone (262) 565-8297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160407001641 | WI | Order and Referring Only - Oral Surgery | 5890093835 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001162-15 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435708800000",
"number": "1144603671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W236S4630 WHISPERING HILLS CT",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531899774",
"telephone_number": "262-565-8297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2305 SILVERNAIL RD",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "530725402",
"telephone_number": "262-548-0770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZELKO",
"first_name": "MARK",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-01",
"last_updated": "2015-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "1001162-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pewaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.