NPIMap

Organization Active NPI

Trimark Dental Clinic, LLP

  • General Practice Dentistry
  • Janesville, WI
National Provider Identifier
1366772204
Registry record updated Dec 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0004660 Issued in WI
Legal business name
TRIMARK DENTAL CLINIC, LLP
Practice address
2130 Kennedy Rd
Janesville, WI 53545-0887
Phone
(608) 752-7452
Fax
(608) 752-4918
NPI assigned
Dec 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2009

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

Authorized official

Name
Dr. Patricia Ann Lyons, D.D.S.NPI 1326139551
Title
Dentist/Partner
Phone
(608) 752-7452

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 0004660 WI Primary

Addresses

Primary practice location

2130 Kennedy Rd
Janesville, WI 53545-0887

Mailing address

2130 Kennedy Rd
Janesville, WI 53545-0887
Phone (608) 752-7452

Other identifiers 3

IdentifierTypeStateIssuer
33369200MedicaidWI
33788200MedicaidWI
33752400MedicaidWI

National Provider Directory

National Provider Directory

Locations

2130 Kennedy Rd
Janesville, WI 53545
Phone (608) 752-7452

Practitioners & affiliated clinicians

Practitioners 4

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": "1261872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261872000000",
    "number": "1366772204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 KENNEDY RD",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535450887",
            "telephone_number": "608-752-7452",
            "fax_number": "608-752-4918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 KENNEDY RD",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535450887",
            "telephone_number": "608-752-7452",
            "fax_number": "608-752-4918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIMARK DENTAL CLINIC, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-27",
        "last_updated": "2009-12-27",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DENTIST/PARTNER",
        "authorized_official_telephone_number": "608-752-7452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "0004660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33369200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33788200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33752400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2009; 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.