Fall Creek Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3104 Issued in WI

Legal business name

FALL CREEK DENTAL

Practice address

122 State St
Fall Creek, WI 54742

Phone

(715) 877-2113

Fax

(715) 877-3495

NPI assigned

Apr 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tony L Pilgrim, DDSNPI 1861545055

Title

Dentist

Phone

(715) 877-2113

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tony Lee Pilgrim, DDS

  • General Practice Dentistry
  • Fall Creek, WI
  • NPI 1861545055
  NPD (past) Authorized official

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295955342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 STATE ST",
            "address_2": "BOX 66",
            "city": "FALL CREEK",
            "state": "WI",
            "postal_code": "54742",
            "telephone_number": "715-877-2113",
            "fax_number": "715-877-3495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 STATE ST",
            "city": "FALL CREEK",
            "state": "WI",
            "postal_code": "54742",
            "telephone_number": "715-877-2113",
            "fax_number": "715-877-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALL CREEK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PILGRIM",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "715-877-2113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Cook, RN
• Covenant Care LLC (Fall Creek Valley Care Center)
• Virginia Carol Duerst, PHD
• Enigma Psychological Inc.
• Fall Creek Chiropractic Inc.
• Fall Creek Family Dental, LLC
• Fall Creek Pharmacy, Inc. (Fall Creek Pharmacy)
• Fall Creek School District
• Lorri Lynn Hellegers, R.D.H.
• Peter Mandelert Ihle, M.D.

• General Practice Dentistry in Fall Creek, WI
• Providers in Fall Creek, 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 Aug 22, 2020; 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.