Douglas Persich, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

5001644 Issued in WI

Practice address

7130 W Greenfield Ave
West Allis, WI 53214-4708

Phone

(414) 258-2500

Fax

(414) 238-6881

NPI assigned

Aug 8, 2008

Last updated

Aug 8, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Douglas Persich, DDS

  dba West Allis Dental Care, LLC

  • General Practice Dentistry
  • West Allis, WI
  • NPI 1174604888
  NPD (past) Authorized official
• Keystone West Allis LLC West Allis Dental Care

  • Dental Clinic/Center
  • West Allis, WI
  • NPI 1588297584
  NPD (past)

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218153600000",
    "number": "1205082377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7130 W GREENFIELD AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532144708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7130 W GREENFIELD AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532144708",
            "telephone_number": "414-258-2500",
            "fax_number": "414-238-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSICH",
        "first_name": "DOUGLAS",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-08",
        "last_updated": "2008-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5001644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33540100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina Perez
• Patricia M Periman, MSW, LCSW
• Amy Perkins, M.S.
• Breanna Dinneen Perron, LPC-IT, SAC
• Antonia Perry, RN
• Personal Care Plus Agency
• Ann Kathryn Peterson, N.P.
• Emily Bella Herff Peterson, PA
• Jesse Peterson
• Justin William Peterson, D.O.

• Dentist in West Allis, WI
• Providers in West Allis, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; 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.