NPIMap

Organization Active NPI

Shane Dental LLC

Doing business as Shane Dental

  • Dentist
  • Hudson, WI
National Provider Identifier
1205361862
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
100148715 Issued in WI
Legal business name
SHANE DENTAL LLC
Doing business as
Shane Dental
Practice address
108 Walnut St Unit a
Hudson, WI 54016-4501
Phone
(715) 386-2133
NPI assigned
Apr 20, 2017
Last updated
Apr 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Authorized official

Name
Dr. Kelvin Shane, DDSNPI 1154733095
Title
Owner
Phone
(715) 386-2133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 100148715 WI Primary

Addresses

Primary practice location

108 Walnut St Unit a
Hudson, WI 54016-4501

Mailing address

108 Walnut St Unit a
Hudson, WI 54016-4501
Phone (715) 386-2133

Other names 1

  • Shane Dental Doing business as

National Provider Directory

National Provider Directory

Locations

108 Walnut St
Unit A
Hudson, WI 54016
Phone (715) 386-2133

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1205361862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 WALNUT ST UNIT A",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540164501",
            "telephone_number": "715-386-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 WALNUT ST UNIT A",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540164501",
            "telephone_number": "715-386-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "SHANE",
        "authorized_official_first_name": "KELVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-386-2133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "100148715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shane Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hudson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.