NPIMap

Organization Active NPI

Dental Park SC

  • Dental Clinic/Center
  • Manitowoc, WI
National Provider Identifier
1386636959
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DENTAL PARK SC
Practice address
1503 Randolph CT
Manitowoc, WI 54220-8345
Phone
(920) 682-0321
Fax
(920) 682-3128
NPI assigned
Aug 18, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Daniel Robert Boettcher, DDSNPI 1801889043
Title
Partner Secretary
Phone
(920) 682-0321

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
Dental Clinic/Center 261QD0000X WI Primary

Addresses

Primary practice location

1503 Randolph CT
Manitowoc, WI 54220-8345

Mailing address

1503 Randolph CT
Manitowoc, WI 54220-8345
Phone (920) 682-0321

National Provider Directory

National Provider Directory

Locations

1503 Randolph Ct
Manitowoc, WI 54220
Phone (920) 682-0321

Practitioners & affiliated clinicians

Practitioners 5

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": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386636959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 RANDOLPH CT",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542208345",
            "telephone_number": "920-682-0321",
            "fax_number": "920-682-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 RANDOLPH CT",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542208345",
            "telephone_number": "920-682-0321",
            "fax_number": "920-682-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PARK SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BOETTCHER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PARTNER SECRETARY",
        "authorized_official_telephone_number": "920-682-0321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manitowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.