NPIMap

Organization Active NPI

Periodontal & Implant Specialists of Madison, LLC

  • Dentist
  • Madison, WI
National Provider Identifier
1366614885
Registry record updated Aug 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3628 Issued in WI
Legal business name
PERIODONTAL & IMPLANT SPECIALISTS OF MADISON, LLC
Practice address
49 N Walbridge Ave.
Madison, WI 53717
Phone
(608) 833-2578
Fax
(608) 203-7105
NPI assigned
Mar 25, 2008
Last updated
Aug 27, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL HEALTH ASSOCIATES OF MADISON LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2008

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

Authorized official

Name
Jan K Streich
Title
Clinic Administrator
Phone
(608) 661-6412

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6136 WI
Dentist 122300000X 6215 WI
Dentist 122300000X 3628 WI Primary

Addresses

Primary practice location

49 N Walbridge Ave.
Madison, WI 53717

Mailing address

2971 Chapel Valley Rd.
Fitchburg, WI 57311-7240
Phone (608) 661-6400

National Provider Directory

National Provider Directory
Part of
Dental Health Associate

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219795200000",
    "number": "1366614885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2971 CHAPEL VALLEY RD.",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "573117240",
            "telephone_number": "608-661-6400",
            "fax_number": "608-661-6414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 N WALBRIDGE AVE.",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53717",
            "telephone_number": "608-833-2578",
            "fax_number": "608-203-7105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL & IMPLANT SPECIALISTS OF MADISON, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL HEALTH ASSOCIATES OF MADISON LTD",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-08-27",
        "status": "A",
        "authorized_official_last_name": "STREICH",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "608-661-6412"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6136",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6215",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "3628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; 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.