Crystal River Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CRYSTAL RIVER DENTAL, LLC

Practice address

400 School St
Waupaca, WI 54981-1626

Phone

(616) 450-9270

NPI assigned

Jul 27, 2020

Last updated

Jul 27, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kelly A Bellinger

Title

Operations Manager

Phone

(616) 450-9270

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1255940227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SCHOOL ST",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811626",
            "telephone_number": "616-450-9270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SCHOOL ST",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811626",
            "telephone_number": "616-450-9270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL RIVER DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "BELLINGER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "616-450-9270",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia L Cook, SAC
• County of Waupaca (Waupaca County Dept of Human Services)
• County of Waupaca (Waupaca County Dept of Human Services)
• Stephanie Jean Crane, LCSW
• Crossroads Care Center of Crystal River LLC
• Cody W Dagnall, OD
• Ismail A Dania, MD
• Daniel L. Gauerkei Dba Broadway Vision Center (Broadway Vision Center)
• Tracy Marie Darnutzer, OTR
• Amanda Debauche, OTR

• Dental Clinic/Center in Waupaca, WI
• Providers in Waupaca, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.