Stacey Lee Bisenius, R.D.H.
Individual provider Active NPI Dental Hygienist · Lakewood, WI
NPI 1386708378 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1386708378
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 6563016 (WI)
- Practice address
- 15397 State Hwy 32
Lakewood, WI 54138 - Phone
- (715) 276-6321
- NPI assigned
- Dec 21, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6563016 | WI | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Lakes Community Health Center, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 6563016 | WI | Yes |
Addresses
Primary practice location
15397 State Hwy 32
Lakewood, WI 54138
Mailing address
PO Box 179
Lakewood, WI 54138-0179
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33805900 | Medicaid | WI |
Other providers in Lakewood, WI
- Assure Family Practice LLC
- Katelyn Boney
- Peggy S Christianson
- Janet M Dailey
- Melissa Day
- Muhammad Saadah Diab
All providers in Lakewood, WI · Dental Hygienist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.