Brian R Teclaw, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3325 Issued in WI

Practice address

2301 S 108TH St
West Allis, WI 53227-1901

Phone

(414) 321-2320

Fax

(414) 321-2766

NPI assigned

Jun 27, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214524800000",
    "number": "1417119710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 S 108TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271901",
            "telephone_number": "414-321-2320",
            "fax_number": "414-321-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 S 108TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271901",
            "telephone_number": "414-321-2320",
            "fax_number": "414-321-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TECLAW",
        "first_name": "BRIAN",
        "middle_name": "R",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-27",
        "last_updated": "2008-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in West Allis, WI
• Providers in West Allis, 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 Jun 27, 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.