NPIMap

Organization Active NPI

Complete Family Dentistry on Broadway

  • General Practice Dentistry
  • Waukesha, WI
National Provider Identifier
1174524425
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3689 Issued in WI
Legal business name
COMPLETE FAMILY DENTISTRY ON BROADWAY
Practice address
419 E Broadway
Waukesha, WI 53186-5082
Phone
(262) 549-6850
Fax
(262) 549-2157
NPI assigned
Aug 9, 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
Dr. Karen M Jahimiak, DDSNPI 1063792216
Title
Partner
Phone
(262) 549-6850

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 3689 WI Primary

Addresses

Primary practice location

419 E Broadway
Waukesha, WI 53186-5082

Mailing address

419 E Broadway
Waukesha, WI 53186-5082
Phone (262) 549-6850

Other identifiers 1

IdentifierTypeStateIssuer
33495600MedicaidWI

Other names 1

  • complete family dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

419 E Broadway
Waukesha, WI 53186
Phone (262) 549-6850

Practitioners & affiliated clinicians

Practitioners 6

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174524425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 E BROADWAY",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531865082",
            "telephone_number": "262-549-6850",
            "fax_number": "262-549-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 E BROADWAY",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531865082",
            "telephone_number": "262-549-6850",
            "fax_number": "262-549-2157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE FAMILY DENTISTRY ON BROADWAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JAHIMIAK",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "262-549-6850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33495600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "complete family dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukesha, 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.