Active NPI
Timothy J Tikalsky, D.D.S.
- Dentist
- Wauwatosa, WI
National Provider Identifier
1306058326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6124015
- Practice address
- 11407 W Bluemound Rd
Wauwatosa, WI 53226 - Phone
- (414) 258-0120
- Fax
- (414) 259-9850
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6124015 | WI | Primary |
Addresses
Primary practice location
11407 W Bluemound Rd
Wauwatosa, WI 53226
Mailing address
11407 W Bluemound Rd
Wauwatosa, WI 53226
Phone (414) 258-0120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160203001340 | WI | Order and Referring Only - Other (Physician) | 7214231703 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6124015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531267200000",
"number": "1306058326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11407 W BLUEMOUND RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "53226",
"telephone_number": "414-258-0120",
"fax_number": "414-259-9850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11407 W BLUEMOUND RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "53226",
"telephone_number": "414-258-0120",
"fax_number": "414-259-9850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIKALSKY",
"first_name": "TIMOTHY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2018-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6124015",
"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 Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.