NPIMap

Organization Active NPI

Sussex Family Dental LLC

  • General Practice Dentistry
  • Sussex, WI
National Provider Identifier
1235619495
Registry record updated Oct 8, 2020
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1001191-15 Issued in WI
Legal business name
SUSSEX FAMILY DENTAL LLC
Practice address
W249N5245 Executive Dr Ste 206
Sussex, WI 53089-4393
Phone
(243) 660-4062
NPI assigned
Aug 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Authorized official

Name
Dr. Syed Rehman, DMD
Title
Owner
Phone
(847) 915-2827

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 1001191-15 WI Primary

Addresses

Primary practice location

W249N5245 Executive Dr Ste 206
Sussex, WI 53089-4393

Mailing address

W249N5245 Executive Dr Ste 206
Sussex, WI 53089-4393

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1534464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1235619495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W249N5245 EXECUTIVE DR STE 206",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530894393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W249N5245 EXECUTIVE DR STE 206",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530894393",
            "telephone_number": "243-660-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSSEX FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-17",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "REHMAN",
        "authorized_official_first_name": "SYED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-915-2827",
        "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": "1001191-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sussex, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.