NPIMap

Organization Active NPI

Baxa Dental Inc., S.C.

  • General Practice Dentistry
  • Independence, WI
National Provider Identifier
1457361941
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0003045 Issued in WI
Legal business name
BAXA DENTAL INC., S.C.
Practice address
35791 Osseo Rd
Independence, WI 54747-9096
Phone
(715) 985-3316
Fax
(715) 985-2542
NPI assigned
Aug 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. William J. Baxa, DDSNPI 1770695892
Title
Owner/President
Phone
(715) 985-3316

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0003045 WI Primary

Addresses

Primary practice location

35791 Osseo Rd
Independence, WI 54747-9096

Mailing address

35791 Osseo Rd
PO Box 550
Independence, WI 54747-9096
Phone (715) 985-3316

Other identifiers 2

IdentifierTypeStateIssuer
33445800MedicaidWI
76993OtherWIWPS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457361941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35791 OSSEO RD",
            "address_2": "PO BOX 550",
            "city": "INDEPENDENCE",
            "state": "WI",
            "postal_code": "547479096",
            "telephone_number": "715-985-3316",
            "fax_number": "715-985-2542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35791 OSSEO RD",
            "city": "INDEPENDENCE",
            "state": "WI",
            "postal_code": "547479096",
            "telephone_number": "715-985-3316",
            "fax_number": "715-985-2542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXA DENTAL INC., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAXA",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "715-985-3316",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "0003045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33445800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WPS",
            "identifier": "76993",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.