NPIMap

Organization Active NPI

Waterford Family Dental LLC

  • Dental Clinic/Center
  • Waterford, WI
National Provider Identifier
1316081441
Registry record updated Apr 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3199-015 Issued in WI
Legal business name
WATERFORD FAMILY DENTAL LLC
Practice address
107A W Main St
Waterford, WI 53185-4129
Phone
(262) 534-5303
Fax
(262) 514-4388
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2019

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

Authorized official

Name
Mr. Dan Trittin, DDSNPI 1922166198
Title
Owner
Phone
(262) 534-5303

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3199-015 WI Primary

Addresses

Primary practice location

107A W Main St
Waterford, WI 53185-4129

Mailing address

107A W Main St
Waterford, WI 53185-4129
Phone (262) 534-5303

National Provider Directory

National Provider Directory

Locations

107A W Main St
Waterford, WI 53185
Phone (262) 534-5303

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555891200000",
    "number": "1316081441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107A W MAIN ST",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531854129",
            "telephone_number": "262-534-5303",
            "fax_number": "262-514-4388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107A W MAIN ST",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531854129",
            "telephone_number": "262-534-5303",
            "fax_number": "262-514-4388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2019-04-22",
        "status": "A",
        "authorized_official_last_name": "TRITTIN",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-534-5303",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": "3199-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2019; 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.