Zachery Daniel Finnegan – General Practice Dentistry

Key facts

NPI: 1386225985
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 1002576-15 (WI)
Practice address: 4660 W College Ave
Appleton, WI 54913-8507
Phone: (920) 730-0345
NPI assigned: Apr 16, 2021
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Dental Associates LTD of Wisconsin Endodontics · Wauwatosa, WI · NPI 1518266998

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20231127000918	WI	Order and Referring Only - Dentist Practitioner - Dentist	2961850300

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Dental Associates LTD of Wisconsin	General Practice	Past since Apr 20, 2021	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Student in an Organized Health Care Education/Training Program	390200000X
General Practice Dentistry	1223G0001X	1002576-15	WI	Yes

Addresses

Primary practice location

4660 W College Ave
Appleton, WI 54913-8507

Mailing address

4660 W College Ave
Appleton, WI 54913-8507
Phone (920) 730-0345

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 17, 2021.

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1386225985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4660 W COLLEGE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138507",
            "telephone_number": "920-730-0345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 W COLLEGE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138507",
            "telephone_number": "920-730-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FINNEGAN",
        "first_name": "ZACHERY",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-16",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002576-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

All providers in Appleton, WI · General Practice Dentistry in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.