NPIMap

Organization Active NPI

Seubert Family Dentistry, LLC

  • General Practice Dentistry
  • Portage, WI
National Provider Identifier
1366848509
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3967 Issued in WI
Legal business name
SEUBERT FAMILY DENTISTRY, LLC
Practice address
260 W. Cook St.
Portage, WI 53901-2106
Phone
(608) 742-2331
Fax
(608) 742-4308
NPI assigned
Nov 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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

Authorized official

Name
Mr. Jan Lloyd Seubert, DDSNPI 1154540615
Title
Dr./Dentist
Phone
(608) 742-2331

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 3967 WI Primary

Addresses

Primary practice location

260 W. Cook St.
Portage, WI 53901-2106

Mailing address

260 W. Cook St.
Portage, WI 53901-2106
Phone (608) 742-2331

National Provider Directory

National Provider Directory

Locations

260 W Cook St
Portage, WI 53901
Phone (608) 742-2331

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": "1416182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1366848509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 W. COOK ST.",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539012106",
            "telephone_number": "608-742-2331",
            "fax_number": "608-742-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 W. COOK ST.",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539012106",
            "telephone_number": "608-742-2331",
            "fax_number": "608-742-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEUBERT FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-17",
        "last_updated": "2014-11-18",
        "status": "A",
        "authorized_official_last_name": "SEUBERT",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "LLOYD",
        "authorized_official_title_or_position": "DR./DENTIST",
        "authorized_official_telephone_number": "608-742-2331",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; 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.