Upali Elavia, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1001913-15 Issued in WI

Practice address

951 Main St Ste 100
Union Grove, WI 53182-1074

Phone

(262) 878-2422

NPI assigned

Sep 27, 2018

Last updated

Sep 27, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1538006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1174008965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 MAIN ST STE 100",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "531821074",
            "telephone_number": "262-878-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 MAIN ST STE 100",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "531821074",
            "telephone_number": "262-878-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELAVIA",
        "first_name": "UPALI",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-27",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001913-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Marie Czajkowski, MS, MHP
• Gerald A Demers, MD
• Lauren Devries
• Drlullaby LLC
• Jenna Dundas
• Allison Epping
• Taryn Kline Fernandes, MD
• Kristin Fields
• Amanda Fontenot, DPT
• Gallina Health Care Network, LTD (Timber Oaks)

• General Practice Dentistry in Union Grove, WI
• Providers in Union Grove, 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 Sep 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.