NPIMap

Organization Active NPI

Lakeshore Family Dental Care SC

  • Dentist
  • Racine, WI
National Provider Identifier
1215058532
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3520 Issued in WI
Legal business name
LAKESHORE FAMILY DENTAL CARE SC
Practice address
3903 Douglas Ave
Racine, WI 53402
Phone
(262) 639-1272
NPI assigned
Apr 3, 2007
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
Dr. Edward J Oshiro, DDSNPI 1225297369
Title
Dentist
Phone
(262) 639-1272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 3520 WI Primary

Addresses

Primary practice location

3903 Douglas Ave
Racine, WI 53402

Mailing address

PO Box 044290
Racine, WI 53404
Phone (262) 639-1272

Other identifiers 1

IdentifierTypeStateIssuer
33487600OtherEDS TITLE 19

Other names 1

  • Edward J Oshiro DDS Mary J Panyk Oshiro DDS Other name

National Provider Directory

National Provider Directory

Locations

3903 Douglas Ave
Racine, WI 53402
Phone (262) 639-1272

Practitioners & affiliated clinicians

Practitioners 3

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": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215058532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 044290",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53404",
            "telephone_number": "262-639-1272",
            "fax_number": "262-639-8870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 DOUGLAS AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53402",
            "telephone_number": "262-639-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE FAMILY DENTAL CARE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OSHIRO",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "262-639-1272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "3520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS TITLE 19",
            "identifier": "33487600",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edward J Oshiro DDS Mary J Panyk Oshiro DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Racine, 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.