NPIMap

Organization Active NPI

Sandberg Modern Dental LLC

  • General Practice Dentistry
  • Wauwatosa, WI
National Provider Identifier
1285029652
Registry record updated Apr 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
WI 6664-15 Issued in WI
Legal business name
SANDBERG MODERN DENTAL LLC
Practice address
6535 W North Ave
Wauwatosa, WI 53213-2016
Phone
(414) 258-8190
NPI assigned
Apr 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2015

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

Authorized official

Name
Dr. Matthew Sandberg, DMDNPI 1851617229
Title
Owner
Phone
(414) 258-8190

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 WI 6664-15 WI Primary

Addresses

Primary practice location

6535 W North Ave
Wauwatosa, WI 53213-2016

Mailing address

6535 W North Ave
Wauwatosa, WI 53213-2016
Phone (414) 258-8190

National Provider Directory

National Provider Directory

Locations

6535 W North Ave
Wauwatosa, WI 53213
Phone (414) 258-8190

Practitioners & affiliated clinicians

Practitioners 4

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": "1427932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1285029652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6535 W NORTH AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132016",
            "telephone_number": "414-258-8190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6535 W NORTH AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132016",
            "telephone_number": "414-258-8190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDBERG MODERN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-02",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "SANDBERG",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-258-8190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "WI 6664-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; 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.