Individual provider Active NPI

Paul Chester Mroczkowski, D.D.S.

  • General Practice Dentistry
  • West Allis, WI
National Provider Identifier
1194862763
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2514 Issued in WI
Practice address
3044 S 92ND St
West Allis, WI 53227-3678
Phone
(414) 321-7744
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
Yes

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 2514 WI Primary

Addresses

Primary practice location

3044 S 92ND St
West Allis, WI 53227-3678

Mailing address

3044 S 92ND St
West Allis, WI 53227-3678
Phone (414) 321-7744

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
I20150603000985 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4880915826

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2514WIMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194862763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3044 S 92ND ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532273678",
            "telephone_number": "414-321-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3044 S 92ND ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532273678",
            "telephone_number": "414-321-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MROCZKOWSKI",
        "first_name": "PAUL",
        "middle_name": "CHESTER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.