NPIMap

Organization Active NPI

De Pere Smiles Acquisition Company S.C.

Doing business as De Pere Smiles S.C.

  • General Practice Dentistry
  • De Pere, WI
National Provider Identifier
1225568983
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1001273-15 Issued in WI
Legal business name
DE PERE SMILES ACQUISITION COMPANY S.C.
Doing business as
De Pere Smiles S.C.
Practice address
277 N 9TH St
De Pere, WI 54115-1548
Phone
(920) 336-6594
Fax
(920) 336-7132
NPI assigned
Jun 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Christopher James Peterson, DMDNPI 1427437219
Title
President/Owner/Dentist
Phone
(920) 336-6594

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 1001273-15 WI Primary

Addresses

Primary practice location

277 N 9TH St
De Pere, WI 54115-1548

Mailing address

277 N 9TH St
De Pere, WI 54115-1548
Phone (920) 336-6594

Other names 1

  • De Pere Smiles S.C. Doing business as

National Provider Directory

National Provider Directory

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": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1225568983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 N 9TH ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151548",
            "telephone_number": "920-336-6594",
            "fax_number": "920-336-7132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 N 9TH ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151548",
            "telephone_number": "920-336-6594",
            "fax_number": "920-336-7132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE PERE SMILES ACQUISITION COMPANY S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT/OWNER/DENTIST",
        "authorized_official_telephone_number": "920-336-6594",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001273-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "De Pere Smiles S.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Pere, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.