Summit Square Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SUMMIT SQUARE DENTAL LLC

Practice address

3228 Turnberry Oak Dr
Waukesha, WI 53188-3969

Phone

(262) 544-0171

NPI assigned

Dec 13, 2016

Organization subpart

Yes

Parent organization

STEPPING STONE DENTAL PARTNERSAs reported in NPPES

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

Authorized official

Name

Timothy J Mathison

Title

President & Ceo

Phone

(608) 709-8303

Specialties & licenses 1

Addresses

Other names 1

• Summit Square Dentistry Former legal business name

Locations

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481587200000",
    "number": "1144764978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3228 TURNBERRY OAK DR",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883969",
            "telephone_number": "262-544-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3228 TURNBERRY OAK DR",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883969",
            "telephone_number": "262-544-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT SQUARE DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEPPING STONE DENTAL PARTNERS",
        "enumeration_date": "2016-12-13",
        "last_updated": "2016-12-13",
        "status": "A",
        "authorized_official_last_name": "MATHISON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "608-709-8303"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Square Dentistry",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kristine Sullivan, MD
• Mackenzie K Sullivan, RN
• Catherine M Suminski, M.S. OTR
• Summit Counseling LLC
• Summit Medical Specialists, SC
• Sunset Dental Care SC
• Sunset Dental Care, S.C.
• Sunst Dental Care SC
• Supportive Home Living Services, Inc.
• Holly Surges, APNP

• Dental Clinic/Center in Waukesha, WI
• Providers in Waukesha, 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 Dec 13, 2016; 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.