NPIMap

Organization Active NPI

The Kids Dentist LLC

  • Pediatric Dentistry
  • Mequon, WI
National Provider Identifier
1407257108
Registry record updated Sep 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5127-015 Issued in WI
Legal business name
THE KIDS DENTIST LLC
Practice address
10618 N Port Washington Rd
Mequon, WI 53092-5013
Phone
(262) 241-0400
NPI assigned
Sep 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2014

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

Authorized official

Name
Dr. Shane Fisher, DDS
Title
Owner
Phone
(262) 241-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 5127-015 WI Primary

Addresses

Primary practice location

10618 N Port Washington Rd
Mequon, WI 53092-5013

Mailing address

10618 N Port Washington Rd
Mequon, WI 53092-5013
Phone (262) 241-0400

National Provider Directory

National Provider Directory

Locations

10618 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-0400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1410480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410480000000",
    "number": "1407257108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10618 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925013",
            "telephone_number": "262-241-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10618 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925013",
            "telephone_number": "262-241-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KIDS DENTIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-12",
        "last_updated": "2014-09-12",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-241-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "5127-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; 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.