NPIMap

Organization Active NPI

Waterloo Family Dental,

  • General Practice Dentistry
  • Waterloo, WI
National Provider Identifier
1437571320
Registry record updated Jan 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WATERLOO FAMILY DENTAL,
Practice address
245 N. Monroe Street
Waterloo, WI 53594
Phone
(920) 478-2850
NPI assigned
Jan 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2014

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

Authorized official

Name
Adam Forster
Title
President Owner Doctor
Phone
(920) 623-5559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

245 N. Monroe Street
Waterloo, WI 53594

Mailing address

245 N. Monroe Street
Waterloo, WI 53594
Phone (920) 478-2850

National Provider Directory

National Provider Directory
Tax ID family
Columbus Family Dental Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

245 N Monroe St
Waterloo, WI 53594
Phone (920) 478-2850

Practitioners & affiliated clinicians

Practitioners 1

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": "1389312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389312000000",
    "number": "1437571320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 N. MONROE STREET",
            "city": "WATERLOO",
            "state": "WI",
            "postal_code": "53594",
            "telephone_number": "920-478-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 N. MONROE STREET",
            "city": "WATERLOO",
            "state": "WI",
            "postal_code": "53594",
            "telephone_number": "920-478-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERLOO FAMILY DENTAL,",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-10",
        "last_updated": "2014-01-10",
        "status": "A",
        "authorized_official_last_name": "FORSTER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT OWNER DOCTOR",
        "authorized_official_telephone_number": "920-623-5559"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; 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.