Comprehensive Dental Services LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2475-015 Issued in WI

Legal business name

COMPREHENSIVE DENTAL SERVICES LTD

Practice address

10521 N Port Washington Rd
Suite 200
Mequon, WI 53092

Phone

(262) 241-2060

Fax

(262) 241-2064

NPI assigned

Dec 6, 2006

Organization subpart

No

Name

Dr. Marc Jacobson, DDS

Title

Vice President

Phone

(262) 241-2060

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154480002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10521 N PORT WASHINGTON RD",
            "address_2": "SUITE 200",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "53092",
            "telephone_number": "262-241-2060",
            "fax_number": "262-241-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10521 N PORT WASHINGTON RD",
            "address_2": "SUITE 200",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "53092",
            "telephone_number": "262-241-2060",
            "fax_number": "262-241-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE DENTAL SERVICES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "262-241-2060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2475-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33412900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33378400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.