John Mark Eaton, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4525-015 Issued in WI

Practice address

107 Warren St Ste 1
Beaver Dam, WI 53916-3031

Phone

(920) 887-7667

NPI assigned

May 2, 2007

Sex

Male

Sole proprietor

Yes

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 May 20, 2015 through May 20, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265654107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6836 STARBURST DR",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535909119",
            "telephone_number": "608-837-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WARREN ST STE 1",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163031",
            "telephone_number": "920-887-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EATON",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4525-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Dull II, PHARMD
• Brian J Dvorak, PT
• Dycora Transitional Health - Beaver Dam LLC
• Brenda W Dykstra, OTR
• Lori A Dykstra, OT
• Heather Marie Edwards
• Ellen Joyce Ellingsworth, MS, RD, CD
• Elizabeth Ann Elsaesser, PA-C
• Emerging Vision, Inc (Sterling Optical #118)
• Catherine Elizabeth Ernst, MS/CCC-SLP

• General Practice Dentistry in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• General Practice Dentistry 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.