Active NPI
Elliot Shambeau
- Dentist
- West Bend, WI
National Provider Identifier
1285329177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6001215-15
- Practice address
- 2930 County Hwy NN
West Bend, WI 53095-2186 - Phone
- (262) 338-8704
- NPI assigned
- Apr 7, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 6001215-15 | WI | Primary |
Addresses
Primary practice location
2930 County Hwy NN
West Bend, WI 53095-2186
Mailing address
2930 County Hwy NN
West Bend, WI 53095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001215-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gentle Dental Management LLC | Dentist | Current | Accepting new patients |
Locations
2930 Cty Highway NN
West Bend, WI 53095
Phone (262) 338-8704
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687737600000",
"number": "1285329177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2930 COUNTY HWY NN",
"city": "WEST BEND",
"state": "WI",
"postal_code": "53095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2930 COUNTY HWY NN",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530952186",
"telephone_number": "262-338-8704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMBEAU",
"first_name": "ELLIOT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-07",
"last_updated": "2023-06-26",
"certification_date": "2023-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6001215-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.