Aline Dufresne, D.M.D

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

1001422-15 Issued in WI

Practice address

10155 Washington Ave
Sturtevant, WI 53177-1645

Phone

(262) 664-7743

Fax

(262) 664-7799

NPI assigned

May 31, 2013

Last updated

Apr 25, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1376980300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 N WATER ST",
            "address_2": "APT 507",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532022793",
            "telephone_number": "410-491-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10155 WASHINGTON AVE",
            "city": "STURTEVANT",
            "state": "WI",
            "postal_code": "531771645",
            "telephone_number": "262-664-7743",
            "fax_number": "262-664-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFRESNE",
        "first_name": "ALINE",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "1001422-15",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "15724",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "097733100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenelle Berce, DPT
• Robert Stephen Callaghan, M.D.
• Latrisha R Davis
• Ryan K Deibert, O.D.
• Carlton L Donowa, DDS
• Ciara Glancy, DDS
• Goodell Chiropractic Office
• Gray Matter Solutions LLC
• Michelle Lynne Guidry, APRFNP
• Donald Craig Gundlach, D.D.S.

• Pediatric Dentistry in Sturtevant, WI
• Providers in Sturtevant, WI by specialty
• Pediatric Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.