NPIMap

Organization Active NPI

Mishicot Dental

  • General Practice Dentistry
  • Mishicot, WI
National Provider Identifier
1407006869
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5096-015 Issued in WI
Legal business name
MISHICOT DENTAL
Practice address
105 N Park LN
Mishicot, WI 54228-9537
Phone
(920) 755-2336
NPI assigned
Sep 23, 2008
Last updated
Sep 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Authorized official

Name
Dr. Jason Allen ThielNPI 1407867773
Title
President / Dentist
Phone
(920) 755-2336

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 Dentistry 1223G0001X 5096-015 WI Primary

Addresses

Primary practice location

105 N Park LN
Mishicot, WI 54228-9537

Mailing address

105 N Park LN
Mishicot, WI 54228-9537
Phone (920) 755-2336

National Provider Directory

National Provider Directory

Locations

105 N Park Ln
Mishicot, WI 54228
Phone (920) 755-2336

Practitioners & affiliated clinicians

Practitioners 2

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": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1407006869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N PARK LN",
            "city": "MISHICOT",
            "state": "WI",
            "postal_code": "542289537",
            "telephone_number": "920-755-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N PARK LN",
            "city": "MISHICOT",
            "state": "WI",
            "postal_code": "542289537",
            "telephone_number": "920-755-2336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISHICOT DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-23",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "THIEL",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT / DENTIST",
        "authorized_official_telephone_number": "920-755-2336",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5096-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishicot, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; 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.