NPIMap

Organization Active NPI

Pediatric Dental Specialists of Madison LLC

  • Dentist
  • Madison, WI
National Provider Identifier
1437310604
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5488 Issued in WI
Legal business name
PEDIATRIC DENTAL SPECIALISTS OF MADISON LLC
Practice address
49 N Walbridge Ave
Madison, WI 53714
Phone
(608) 246-2555
Fax
(608) 246-3687
NPI assigned
Jun 20, 2008
Organization subpart
Yes
Parent organization
DENTAL HEALTH ASSOCIATES OF MADISON LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Jan K Streich
Title
Clinic Administrator
Phone
(608) 661-6412

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 5488 WI Primary

Addresses

Primary practice location

49 N Walbridge Ave
Madison, WI 53714

Mailing address

2971 Chapel Valley Rd
Fitchburg, WI 53711
Phone (608) 661-6400

National Provider Directory

National Provider Directory
Part of
Dentl HLTH Assoc LTD

Locations

49 N Walbridge Ave
Madison, WI 53714
Phone (608) 246-2555

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

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": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1437310604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2971 CHAPEL VALLEY RD",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "53711",
            "telephone_number": "608-661-6400",
            "fax_number": "608-661-6414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 N WALBRIDGE AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53714",
            "telephone_number": "608-246-2555",
            "fax_number": "608-246-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL SPECIALISTS OF MADISON LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL HEALTH ASSOCIATES OF MADISON LTD",
        "enumeration_date": "2008-06-20",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "STREICH",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "608-661-6412"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "5488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.