Generations Family Dental Care-Random Lake, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GENERATIONS FAMILY DENTAL CARE-RANDOM LAKE, LLC

Practice address

37 Hickory Dr
Random Lake, WI 53075-1675

Phone

(920) 994-4367

NPI assigned

Mar 22, 2017

Last updated

Mar 22, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Fred Lacourt, DDS, FAGDNPI 1407925803

Title

Manager

Phone

(414) 258-2117

Specialties & licenses 1

Addresses

Locations

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.

• Fred A Lacourt, DDS

  • General Practice Dentistry
  • Wauwatosa, WI
  • NPI 1407925803
  Authorized official Same address or phone
• Gerald Linus Vogler, DDS

  • General Practice Dentistry
  • Random Lake, WI
  • NPI 1801086475
  NPD (past)

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1407387483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 N MAYFAIR RD",
            "address_2": "SUITE 103",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261404",
            "telephone_number": "414-258-2117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 HICKORY DR",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751675",
            "telephone_number": "920-994-4367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERATIONS FAMILY DENTAL CARE-RANDOM LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-22",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "LACOURT",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "414-258-2117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, FAGD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia K Bowen, P.T.
• Angela Cabell, M.S. CCC-SLP
• Jamie L. Carter, OTR
• Nichole M. Cruz, O.D.
• Michelle L Feierstein, OTR
• Carolyn Ann Gilley
• Michelle M Grace-Jensen, PT
• Megan C Horn, OTR
• Ideal Chiropractic
• Jensen Interhealth (PT Connections)

• General Practice Dentistry in Random Lake, WI
• Providers in Random Lake, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; 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.