Active NPI
Dave John Litzow, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Fond Du Lac, WI
National Provider Identifier
1457388084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 5000183-015
- Practice address
- 545 E. Johnson St
Fond Du Lac, WI 54935 - Phone
- (920) 924-9090
- Fax
- (920) 921-0800
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 5000183-015 | WI | Primary |
Addresses
Primary practice location
545 E. Johnson St
Fond Du Lac, WI 54935
Mailing address
545 E Johnson St
Fond Du Lac, WI 54935
Phone (920) 924-9090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33658400 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5000183-015 | WI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Assosiates | Past | Accepting new patients | |
| Dental Associates LTD of Wisconsin | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endodontics
- Wauwatosa, WI
- NPI 1518266998
Orthodontics and Dentofacial Orthopedics
-
- Dental Clinic/Center
- Fond Du Lac, WI
- NPI 1558710269
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494201600000",
"number": "1457388084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 E JOHNSON ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "54935",
"telephone_number": "920-924-9090",
"fax_number": "920-921-0800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 E. JOHNSON ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "54935",
"telephone_number": "920-924-9090",
"fax_number": "920-921-0800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LITZOW",
"first_name": "DAVE",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2017-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WI",
"license": "5000183-015",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33658400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.