Individual provider Active NPI

Faith C Pristel-Miller

  • General Practice Dentistry
  • Peshtigo, WI
National Provider Identifier
1215057401
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4464 Issued in WI
Practice address
141 W Front St
Peshtigo, WI 54157-1421
Phone
(715) 582-3601
NPI assigned
Mar 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 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 4464 WI Primary

Addresses

Primary practice location

141 W Front St
Peshtigo, WI 54157-1421

Mailing address

141 W Front St
Peshtigo, WI 54157-1421
Phone (715) 582-3601

Other identifiers 1

IdentifierTypeStateIssuer
33736400MedicaidWI

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
I20160428001716 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4284933060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
David R. Brostowitz, DDS, SC General Practice Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1215057401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W FRONT ST",
            "city": "PESHTIGO",
            "state": "WI",
            "postal_code": "541571421",
            "telephone_number": "715-582-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W FRONT ST",
            "city": "PESHTIGO",
            "state": "WI",
            "postal_code": "541571421",
            "telephone_number": "715-582-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRISTEL-MILLER",
        "first_name": "FAITH",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33736400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peshtigo, WI

Sources for this page

Verify at the official NPI Registry.