Carmen M. Ayala-Iwen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4892 Issued in WI

Practice address

613 Center Dr
Luxemburg, WI 54217-1031

Phone

(920) 845-2225

Fax

(920) 845-5627

NPI assigned

Feb 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 10, 2016 through Feb 10, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Abc Family Dental Services, S.C.

  • General Practice Dentistry
  • Luxemburg, WI
  • NPI 1871638254
  NPD (past)

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1306981865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 CENTER DR",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171031",
            "telephone_number": "920-845-2225",
            "fax_number": "920-845-5627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 CENTER DR",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171031",
            "telephone_number": "920-845-2225",
            "fax_number": "920-845-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYALA-IWEN",
        "first_name": "CARMEN",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33740400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abc Family Dental Services, S.C.
• Bellin Memorial Hospital Inc
• Heidi Angela Bouvette, LPN
• Bredael Family Chiropractic
• William Joseph Bredael, B.S., D.C.
• Brighter Routes Transportation LLC

• General Practice Dentistry in Luxemburg, WI
• Providers in Luxemburg, 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 Jul 9, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.