Randolph Family Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3858 Issued in WI

Legal business name

RANDOLPH FAMILY DENTAL LLC

Practice address

125 N High St
Randolph, WI 53956-1267

Phone

(920) 326-3191

NPI assigned

Jan 29, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Ross D Werner, D.D.S.NPI 1801955950

Title

Member

Phone

(920) 326-3191

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ross D Werner, DDS

  • Dentist
  • Randolph, WI
  • NPI 1801955950
  NPD (past) Authorized official
• Myriel Jamae Werner, DDS

  • General Practice Dentistry
  • Randolph, WI
  • NPI 1457961971
  NPD (past)

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

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1154711190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N HIGH ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561267",
            "telephone_number": "920-326-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N HIGH ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561267",
            "telephone_number": "920-326-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-29",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "WERNER",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "920-326-3191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1801955950",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan K North, PTA
• NSH Randolph LLC
• Kristen Rabensdorf
• Randolph Community Clinic SC
• Randolph Community Rescue Ambulance
• Randolph School District
• Shannon N Sandstrom, NP
• Emily J Seltzner, RD
• Wendy Lunnette Sherwood, IBCLC
• Tara Sosalla

• General Practice Dentistry in Randolph, WI
• Providers in Randolph, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.