West Endodontic Group

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

6129-15 Issued in WI

Legal business name

WEST ENDODONTIC GROUP

Doing business as

Lakeside Endodontics

Practice address

1245 Cheyenne Ave
Suite 104
Grafton, WI 53024-9323

Phone

(262) 377-2889

Fax

(262) 377-2680

NPI assigned

Nov 11, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Nicole West, DDS

Title

Owner

Phone

(262) 377-2668

Specialties & licenses 1

Addresses

Other names 1

• Lakeside Endodontics Doing business as

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1417284480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 CHEYENNE AVE",
            "address_2": "SUITE 104",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249323",
            "telephone_number": "262-377-2889",
            "fax_number": "262-377-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 CHEYENNE AVE",
            "address_2": "SUITE 104",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249323",
            "telephone_number": "262-377-2889",
            "fax_number": "262-377-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST ENDODONTIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-377-2668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "WI",
            "license": "6129-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brynn Madison Weiss, LPC
• Bonita J. Wendel, APNP/BC
• Rachel J Werking, OTL/R
• Darren Werner, D.C.
• Anthony Francis Werth Jr., MS
• Kelly Nicole West, DDS
• Jule N Wetherbee, M.D.
• Tonia T Whalen, CRNA
• Nicole White, NP
• Rebecca L White, PA-C

• Endodontics in Grafton, WI
• Providers in Grafton, WI by specialty
• Endodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; 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.