Individual provider Active NPI

Deborah K Kuntz, DDS

  • Dentist
  • Saint Croix Falls, WI
National Provider Identifier
1407141849
Registry record updated Mar 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6762-15 Issued in WI
Practice address
307 N Washington St
Saint Croix Falls, WI 54024-9274
Phone
(715) 557-4839
NPI assigned
Jun 14, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D12988 MN
Dentist 122300000X 6762-15 WI Primary

Addresses

Primary practice location

307 N Washington St
Saint Croix Falls, WI 54024-9274

Mailing address

PO Box 60
Saint Croix Falls, WI 54024-0060
Phone (715) 553-0333

Other practice location 1

591 Apollo Dr
Circle Pines, MN 55014-3005
Phone (651) 786-7630

Other names 1

  • Dr. Deborah K Anderson Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20151016000386 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7315256260

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6762-15WIMDDentist
D12988MNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Breathe and Thrive, LLC CurrentSince Mar 26, 2023 Accepting new patients
Georgeann C. Vargas DDS, LTD Current Accepting new patients

Locations

601 State Road 35
Centuria, WI 54824
Phone (715) 646-2161

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679184000000",
    "number": "1407141849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540240060",
            "telephone_number": "715-553-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 N WASHINGTON ST",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540249274",
            "telephone_number": "715-557-4839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "591 Apollo Dr",
            "address_purpose": "LOCATION",
            "city": "Circle Pines",
            "state": "MN",
            "postal_code": "550143005",
            "country_code": "US",
            "telephone_number": "651-786-7630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUNTZ",
        "first_name": "DEBORAH",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2023-03-19",
        "certification_date": "2023-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12988",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6762-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBORAH",
            "last_name": "ANDERSON",
            "middle_name": "K",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Croix Falls, WI

Sources for this page

Verify at the official NPI Registry.