Sauk Trail Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2334-15 Issued in WI

Legal business name

SAUK TRAIL DENTAL LLC

Practice address

661 E Green Bay Ave
Saukville, WI 53080-2013

Phone

(262) 284-7111

NPI assigned

Dec 21, 2012

Organization subpart

Yes

Parent organization

STEPPING STONE DENTAL PARTNERSAs reported in NPPES

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

Authorized official

Name

Genevieve Poppe

Title

Partner

Phone

(608) 358-3370

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carol Jean Antisdel, D,D,S,

  • General Practice Dentistry
  • Saukville, WI
  • NPI 1821213653
  NPD (past)
• Robert James Antisdel, D.D.S.

  • General Practice Dentistry
  • Saukville, WI
  • NPI 1558586370
  NPD (past)

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

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1457697229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802013",
            "telephone_number": "262-284-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802013",
            "telephone_number": "262-284-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAUK TRAIL DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEPPING STONE DENTAL PARTNERS",
        "enumeration_date": "2012-12-21",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "POPPE",
        "authorized_official_first_name": "GENEVIEVE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "608-358-3370"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "2485-15",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2334-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Pupp, AUD
• Riverside Physical Therapy & Pelvic Health, S.C.
• Riverview Physical Therapy & Sports Medicine ,S.C.
• Cary Joseph Rothman, RPH
• Katelyn Sadler
• Saukville Chiropractic Wellness Center Inc.
• Saukville Family Eye Center LLC
• Julie Schueller, DPT
• Luke William Schueller, PHARMD
• Dee Ann M Smith, MD

• General Practice Dentistry in Saukville, WI
• Providers in Saukville, 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 Jun 4, 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.