Elite Smiles Dental, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6542-15 Issued in WI

Legal business name

ELITE SMILES DENTAL, LTD

Practice address

315 W Wisconsin Ave
Appleton, WI 54911-4355

Phone

(920) 731-2211

Fax

(920) 733-7176

NPI assigned

Feb 24, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Alissa Edwards, D.D.S.

Title

Dentist

Phone

(920) 731-2211

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1154781870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W WISCONSIN AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549114355",
            "telephone_number": "920-731-2211",
            "fax_number": "920-733-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W WISCONSIN AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549114355",
            "telephone_number": "920-731-2211",
            "fax_number": "920-733-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SMILES DENTAL, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-24",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "ALISSA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "920-731-2211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6542-15",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1578874426",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "6542-15",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jane Katherine Eiting, CAPSW
• Samantha A Eiting, APNP
• Vashnie Turielle Honang Eka, MD
• Samuel Ekern, MD
• Elite Medical Transit LLC
• Elite Transportation LLC
• Judy F Ellefson Peil
• Elles Nurturing Circle LLC
• Rachel Lee Elliott, DC
• Katie S Ellis, BCBA

• General Practice Dentistry in Appleton, WI
• Providers in Appleton, 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 Feb 24, 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.