NPIMap

Organization Active NPI

Glendale Optimal Dental Care, Inc.

  • General Practice Dentistry
  • Glendale, WI
National Provider Identifier
1245048925
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GLENDALE OPTIMAL DENTAL CARE, INC.
Practice address
6191 N Green Bay Ave
Glendale, WI 53209-3813
Phone
(414) 404-6464
Fax
(414) 404-6499
NPI assigned
Dec 26, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Authorized official

Name
Dr. Emmanuel Igwike, DDSNPI 1104911239
Title
President
Phone
(414) 217-8236

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 Primary

Addresses

Primary practice location

6191 N Green Bay Ave
Glendale, WI 53209-3813

Mailing address

6191 N Green Bay Ave
Glendale, WI 53209-3813
Phone (414) 404-6464

National Provider Directory

National Provider Directory

Locations

6191 N Green Bay Ave
Glendale, WI 53209
Phone (414) 404-6464

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": "1735171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735171200000",
    "number": "1245048925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6191 N GREEN BAY AVE",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093813",
            "telephone_number": "414-404-6464",
            "fax_number": "414-404-6499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6191 N GREEN BAY AVE",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093813",
            "telephone_number": "414-404-6464",
            "fax_number": "414-404-6499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE OPTIMAL DENTAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-26",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A",
        "authorized_official_last_name": "IGWIKE",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-217-8236",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.