NPIMap

Organization Active NPI

Geneva Family Dentistry

  • General Practice Dentistry
  • Lake Geneva, WI
National Provider Identifier
1205900586
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4060 Issued in WI
Legal business name
GENEVA FAMILY DENTISTRY
Practice address
851 Park Dr
Suite 101
Lake Geneva, WI 53147-4586
Phone
(262) 248-4991
Fax
(262) 248-0397
NPI assigned
Nov 20, 2006
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
Genie Kuble
Title
Contact Officer
Phone
(920) 450-0157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4060 WI Primary

Addresses

Primary practice location

851 Park Dr
Suite 101
Lake Geneva, WI 53147-4586

Mailing address

851 Park Dr
Suite 101
Lake Geneva, WI 53147-4586
Phone (262) 248-4991

National Provider Directory

National Provider Directory

Locations

851 Park Dr
Ste 101
Lake Geneva, WI 53147
Phone (262) 248-4991

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205900586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 PARK DR",
            "address_2": "SUITE 101",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531474586",
            "telephone_number": "262-248-4991",
            "fax_number": "262-248-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 PARK DR",
            "address_2": "SUITE 101",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531474586",
            "telephone_number": "262-248-4991",
            "fax_number": "262-248-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENEVA FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KUBLE",
        "authorized_official_first_name": "GENIE",
        "authorized_official_title_or_position": "CONTACT OFFICER",
        "authorized_official_telephone_number": "920-450-0157"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Geneva, 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.