NPIMap

Organization Active NPI

East Towne Dental Associates Belgium Family Dental SC

  • Dentist
  • Belgium, WI
National Provider Identifier
1164560165
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5304 Issued in WI
Legal business name
EAST TOWNE DENTAL ASSOCIATES BELGIUM FAMILY DENTAL SC
Practice address
171 Main St
Suite 200
Belgium, WI 53004
Phone
(262) 285-3408
Fax
(262) 285-4025
NPI assigned
Feb 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Vali Kiaie, DDSNPI 1083826895
Title
President
Phone
(262) 285-3408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5301 WI
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5304 WI Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5993 WI

Addresses

Primary practice location

171 Main St
Suite 200
Belgium, WI 53004

Mailing address

PO Box 147
Belgium, WI 53004
Phone (262) 285-3408

National Provider Directory

National Provider Directory
Tax ID family
East Towne Dental Associates Belgium Family Dental SC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164560165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 147",
            "city": "BELGIUM",
            "state": "WI",
            "postal_code": "53004",
            "telephone_number": "262-285-3408",
            "fax_number": "262-285-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 MAIN ST",
            "address_2": "SUITE 200",
            "city": "BELGIUM",
            "state": "WI",
            "postal_code": "53004",
            "telephone_number": "262-285-3408",
            "fax_number": "262-285-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TOWNE DENTAL ASSOCIATES BELGIUM FAMILY DENTAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIAIE",
        "authorized_official_first_name": "VALI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-285-3408",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "5301",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "5304",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "5993",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belgium, WI

Sources for this page

  • 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.