NPIMap

Organization Active NPI

Maury Family Dental LLC

  • Dentist
  • Fond Du Lac, WI
National Provider Identifier
1174992937
Registry record updated Oct 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5369015 Issued in WI
Legal business name
MAURY FAMILY DENTAL LLC
Practice address
145 S Marr St
Fond Du Lac, WI 54935-4408
Phone
(920) 921-6260
NPI assigned
Sep 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2015

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

Authorized official

Name
Chris Maury
Title
Owner
Phone
(920) 921-6260

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5369015 WI Primary
Customized Equipment (DME) 332BC3200X 5369015 WI

Addresses

Primary practice location

145 S Marr St
Fond Du Lac, WI 54935-4408

Mailing address

145 S Marr St
Fond Du Lac, WI 54935-4408

National Provider Directory

National Provider Directory

Locations

145 S Marr St
Fond du Lac, WI 54935
Phone (920) 921-6260

Practitioners & affiliated clinicians

Practitioners 2

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": "1442880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1174992937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 S MARR ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S MARR ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354408",
            "telephone_number": "920-921-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAURY FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-22",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "MAURY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-921-6260"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "5369015",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "WI",
            "license": "5369015",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; 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.