NPIMap

Organization Active NPI

Village Family Dental Asscociates

  • General Practice Dentistry
  • Black Earth, WI
National Provider Identifier
1174500813
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
VILLAGE FAMILY DENTAL ASSCOCIATES
Practice address
1209 Mills St
Black Earth, WI 53515-9420
Phone
(608) 767-3604
Fax
(608) 767-3606
NPI assigned
Dec 23, 2005
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
Michael F Peeples, DDS
Title
President of Corporation
Phone
(608) 643-8505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1209 Mills St
Black Earth, WI 53515-9420

Mailing address

1209 Mills St
Black Earth, WI 53515-9420
Phone (608) 767-3604

National Provider Directory

National Provider Directory
Tax ID family
Village Family Dental Asscociates3 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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174500813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 MILLS ST",
            "city": "BLACK EARTH",
            "state": "WI",
            "postal_code": "535159420",
            "telephone_number": "608-767-3604",
            "fax_number": "608-767-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 MILLS ST",
            "city": "BLACK EARTH",
            "state": "WI",
            "postal_code": "535159420",
            "telephone_number": "608-767-3604",
            "fax_number": "608-767-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE FAMILY DENTAL ASSCOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PEEPLES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "608-643-8505",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black Earth, 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.