Active NPI
Kristina Grabowski Connor, DDS
- General Practice Dentistry
- Brookfield, WI
National Provider Identifier
1285731091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5641
- Practice address
- 125 N Executive Dr
Suite 105
Brookfield, WI 53005-6070 - Phone
- (262) 784-7201
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5641 | LA | Primary |
| Dentist | 122300000X | 5645 | WI |
Addresses
Primary practice location
125 N Executive Dr
Suite 105
Brookfield, WI 53005-6070
Mailing address
125 N. Executive Dr.
Suite 105
Brookfield, WI 53005
Phone (262) 784-7201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1856410 | Medicaid | LA |
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 |
|---|---|---|---|
| 5641 | LA | MD | General Practice Dentistry |
| 5645 | WI | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elmbrook Family Dental, S.C. | General Practice | Past | Accepting new patients |
| Elmbrook Family Dental Partners SC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Brookfield, WI
- NPI 1134448632
-
- General Practice Dentistry
- Brookfield, WI
- NPI 1124075023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273795200000",
"number": "1285731091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 N. EXECUTIVE DR.",
"address_2": "SUITE 105",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "53005",
"telephone_number": "262-784-7201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 N EXECUTIVE DR",
"address_2": "SUITE 105",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530056070",
"telephone_number": "262-784-7201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOR",
"first_name": "KRISTINA",
"middle_name": "GRABOWSKI",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2010-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "5641",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5645",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1856410",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.