Otter Creek Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

OTTER CREEK DENTAL, LLC

Practice address

105 Kelly Way
Hortonville, WI 54944-8755

Phone

(920) 740-8706

NPI assigned

Apr 30, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Branden Goetsch, DMD

Title

Owner Dentist

Phone

(920) 740-8706

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Budi, D.D.S.

  • Dentist
  • Hortonville, WI
  • NPI 1134523681
  NPD (past)
• Taylor Marie McElwee, DDS

  • Dentist
  • Hortonville, WI
  • NPI 1871248849
  NPD (past)

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556582400000",
    "number": "1265096812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 KELLY WAY",
            "city": "HORTONVILLE",
            "state": "WI",
            "postal_code": "549448755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 KELLY WAY",
            "city": "HORTONVILLE",
            "state": "WI",
            "postal_code": "549448755",
            "telephone_number": "920-740-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTER CREEK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-30",
        "last_updated": "2019-04-30",
        "status": "A",
        "authorized_official_last_name": "GOETSCH",
        "authorized_official_first_name": "BRANDEN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "920-740-8706",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Marie McElwee, DDS
• Emily Anne Mooren, AU.D.
• Charles Lee Nieuwenhuis, D. C.
• Molly Oleson
• Orthopedic & Spine Therapy of New London, SC
• Colette A. Probasco
• Mitzi Julann Rabe, ED.S.
• Sarah C Reynolds, PT
• Aaron Rohde, RN, BSN
• Angela Schroeder, RN

• Dental Clinic/Center in Hortonville, WI
• Providers in Hortonville, 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 Apr 30, 2019; 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.