NPIMap

Organization Active NPI

Racine Periodontics and Implant Dentistry LTD

  • Periodontics
  • Lake Geneva, WI
National Provider Identifier
1215634266
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
RACINE PERIODONTICS AND IMPLANT DENTISTRY LTD
Practice address
255 Havenwood Dr
Lake Geneva, WI 53147-1988
Phone
(262) 248-8505
NPI assigned
Feb 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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

Authorized official

Name
Dr. Adrian Rivas, DMDNPI 1538303714
Title
Owner
Phone
(305) 807-9082

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
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

255 Havenwood Dr
Lake Geneva, WI 53147-1988

Mailing address

4715 James Ave
Racine, WI 53402-2642
Phone (305) 807-9082

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1675900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675900800000",
    "number": "1215634266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 JAMES AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534022642",
            "telephone_number": "305-807-9082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 HAVENWOOD DR",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531471988",
            "telephone_number": "262-248-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RACINE PERIODONTICS AND IMPLANT DENTISTRY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-09",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A",
        "authorized_official_last_name": "RIVAS",
        "authorized_official_first_name": "ADRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-807-9082",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "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 Feb 9, 2023; 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.