Individual provider Active NPI

Melanie E. White, D.D.S.

  • General Practice Dentistry
  • Evansville, WI
National Provider Identifier
1164574992
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5601-015 Issued in WI
Practice address
39 W Church St
Evansville, WI 53536-1329
Phone
(608) 882-4860
Fax
(608) 882-4862
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5601-015 WI Primary

Addresses

Primary practice location

39 W Church St
Evansville, WI 53536-1329

Mailing address

39 W Church St
P.O. Box 175
Evansville, WI 53536-1329
Phone (608) 882-4860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150716001721 WI Order and Referring Only - DentistPractitioner - Dentist 7618280884

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5601-015WIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164574992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 W CHURCH ST",
            "address_2": "P.O. BOX 175",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361329",
            "telephone_number": "608-882-4860",
            "fax_number": "608-882-4862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 W CHURCH ST",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361329",
            "telephone_number": "608-882-4860",
            "fax_number": "608-882-4862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "MELANIE",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5601-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, WI

Sources for this page

Verify at the official NPI Registry.