NPIMap

Organization Active NPI

Delevan Family Dentistry

  • General Practice Dentistry
  • Delavan, WI
National Provider Identifier
1427290147
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DELEVAN FAMILY DENTISTRY
Practice address
1624 Hobbs Dr
Suite 2
Delavan, WI 53115-2000
Phone
(262) 740-1010
NPI assigned
Mar 26, 2009
Last updated
Mar 26, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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

Authorized official

Name
Genie Kuble
Title
Contact Officer
Phone
(920) 450-0157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1624 Hobbs Dr
Suite 2
Delavan, WI 53115-2000

Mailing address

1624 Hobbs Dr
Suite 2
Delavan, WI 53115-2000

National Provider Directory

National Provider Directory
Tax ID family
Delavan Family Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1624 Hobbs Dr
Ste 2
Delavan, WI 53115
Phone (262) 740-1010

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1238025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238025600000",
    "number": "1427290147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 HOBBS DR",
            "address_2": "SUITE 2",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531152000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 HOBBS DR",
            "address_2": "SUITE 2",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531152000",
            "telephone_number": "262-740-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELEVAN FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-26",
        "last_updated": "2009-03-26",
        "status": "A",
        "authorized_official_last_name": "KUBLE",
        "authorized_official_first_name": "GENIE",
        "authorized_official_title_or_position": "CONTACT OFFICER",
        "authorized_official_telephone_number": "920-450-0157"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delavan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.