Organization Active NPI

Sussex Family Dental Associates LLC

  • Dentist
  • Sussex, WI
National Provider Identifier
1275403495
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SUSSEX FAMILY DENTAL ASSOCIATES LLC
Practice address
W249N5245 Executive Dr Ste 206
Sussex, WI 53089-4393
Phone
(262) 246-0100
NPI assigned
Nov 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Authorized official

Name
Umar Hayat, DMDNPI 1477227148
Title
Dentist
Phone
(610) 209-0325

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 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
Phone (262) 246-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260105002383 WI Part B Supplier - Clinic/Group Practice 0143716613 Receives reassigned benefits from 1 practitioner
Practice locations: Sussex, WI

National Provider Directory

National Provider Directory

Locations

W249N5245 Executive Dr
Ste 206
Sussex, WI 53089
Phone (262) 246-0100

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": "1762819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1275403495",
    "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",
            "telephone_number": "262-246-0100"
        },
        {
            "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": "262-246-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSSEX FAMILY DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-11",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "HAYAT",
        "authorized_official_first_name": "UMAR",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "610-209-0325",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "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 Nov 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.