Paul Joseph Congdon, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3247-015 Issued in WI

Practice address

1102 Beall St
Hudson, WI 54016-2060

Phone

(715) 386-3675

Fax

(715) 386-0985

NPI assigned

Apr 7, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• St. Croix Tribal Council

  • Federally Qualified Health Center (FQHC)
  • Webster, WI
  • NPI 1831170091
  Medicare reassignment NPD
• Hudson Valley Dental PLLC

  • Dental Clinic/Center
  • Hudson, WI
  • NPI 1588271019
  NPD (past)

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

{
    "created_epoch": "1175904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1457474306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 BEALL ST",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540162060",
            "telephone_number": "715-386-3675",
            "fax_number": "715-386-0985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 BEALL ST",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540162060",
            "telephone_number": "715-386-3675",
            "fax_number": "715-386-0985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONGDON",
        "first_name": "PAUL",
        "middle_name": "JOSEPH",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-07",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3247-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33463900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angelena Cody
• Sara Elizabeth Leonette Cody, DDS
• Taylor Lee Coffin, LADC, LPC, LPCC
• Diana K Cohen, M.D.
• Krystal Coleman, M.A.
• Quincy Conrad, CCC-SLP
• Consumer Direct for Minnesota, LLC
• Consumer Direct for Wisconsin, LLC
• Cook and Henriksen Chiropractic LLC
• Jennifer Marie Cook, BSW, MA OTR/L

• General Practice Dentistry in Hudson, WI
• Providers in Hudson, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.