Gordon D. Korthals, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

4375-015 Issued in WI

Practice address

600 S Main St
Oshkosh, WI 54902-6074

Phone

(920) 233-8882

Fax

(920) 303-2736

NPI assigned

Feb 13, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2005 through Apr 1, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Terry L. Kippa DDS SC

  dba Terry L. Kippa, DDS and Gordon D. Korthals, DDS

  • Endodontics
  • Oshkosh, WI
  • NPI 1487812855
  NPD (past) Authorized official

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235271792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S. MAIN ST.",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "54902",
            "telephone_number": "920-233-8882",
            "fax_number": "920-303-2736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S MAIN ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549026074",
            "telephone_number": "920-233-8882",
            "fax_number": "920-303-2736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORTHALS",
        "first_name": "GORDON",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WI",
            "license": "4375-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John N Korger, MD
• Shay S Korittnig, CRNA
• Sally May Korn, SOCIAL WORKER
• Kassondra K Korth, APNP
• Mallori Korth
• Spencer A Kostka
• Jessica L Kozel, DNP
• Dana Koziol, REGISTERED NURSE
• Matthew N Kraemer, DO
• Nicole Ann Kraemer, RN

• Endodontics in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Endodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.