NPIMap

Organization Active NPI

Orchard Dental SC

  • Dental Clinic/Center
  • West Allis, WI
National Provider Identifier
1316335763
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
4186 Issued in WI
Legal business name
ORCHARD DENTAL SC
Doing business as
WISCONSIN SMILES
Practice address
1469 S 70TH St
West Allis, WI 53214-4814
Phone
(414) 383-5833
Fax
(414) 383-0233
NPI assigned
Jan 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Authorized official

Name
Dr. Roberto Edgardo Monteagudo, DDSNPI 1750507356
Title
Owner
Phone
(414) 383-5833

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 4186 WI Primary

Addresses

Primary practice location

1469 S 70TH St
West Allis, WI 53214-4814

Mailing address

1469 S 70TH St
West Allis, WI 53214-4814
Phone (414) 383-5833

Other names 1

  • WISCONSIN SMILES Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1420588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1316335763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1469 S 70TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532144814",
            "telephone_number": "414-383-5833",
            "fax_number": "414-383-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1469 S 70TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532144814",
            "telephone_number": "414-383-5833",
            "fax_number": "414-383-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORCHARD DENTAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-07",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "MONTEAGUDO",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_middle_name": "EDGARDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-383-5833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": "4186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WISCONSIN SMILES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Allis, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; 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.