Ernst A. Cornielsen, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1732-G Issued in WI

Practice address

312 Center St
Lake Geneva, WI 53147-1904

Phone

(262) 248-2868

Fax

(262) 248-7274

NPI assigned

Aug 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Geneva Oral and Maxillofacial Surgery, LTD

  • Oral and Maxillofacial Surgery (Dentist)
  • Lake Geneva, WI
  • NPI 1063420206
  NPD (past)

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447268651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W3627 WILDWOOD DR",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531473568",
            "telephone_number": "262-248-2868",
            "fax_number": "262-248-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 CENTER ST",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531471904",
            "telephone_number": "262-248-2868",
            "fax_number": "262-248-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNIELSEN",
        "first_name": "ERNST",
        "middle_name": "A.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "1732-G",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina L. Clancy, C.N.P.
• Marguerite R Compton, MD
• Amie Lee Conley, LPN
• Robert Conlon, D.D.S.
• Cornerstone Adult Family Homes
• Kim M. Cuculi, O.T.R.
• Kimberly K Dama, PT
• Christina Dame, LPC
• Kailin Michele Daniels, COTA
• Michaela Ann Daniels, MS, CCC-SLP

• Oral and Maxillofacial Surgery (Dentist) in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.