Nana Owusu

Primary specialty

DentistTaxonomy code 122300000X

License

D14830 Issued in MN

Practice address

400 Lake Ave
Racine, WI 53403-1020

Phone

(262) 633-0775

NPI assigned

Jul 7, 2022

Last updated

Mar 24, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in MN

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 911 Dental Group

  • Dental Clinic/Center
  • Racine, WI
  • NPI 1235944190
  NPD Authorized official
• Lake Dental Group

  • Dentist
  • Racine, WI
  • NPI 1922314210
  NPD (past)

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1487387437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 LAKE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 LAKE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031020",
            "telephone_number": "262-633-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWUSU",
        "first_name": "NANA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-07",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14830",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001017-15",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Osl 3950 Racine Operating LLC
• Outreach 4 Healthy Teeth, LLC
• Outreach Community Health Centers Inc (Racine Outreach Community Health Center)
• Outreach TLP LLC
• H. Keith Owsley, LAT
• Gregory Pae, MD
• Mary E Pagano, MD
• Stephen J. Pagano, M.D.
• Elmo G Painter-Edington, LPC
• Nickey Lee Paison

• Dentist in Racine, WI
• Providers in Racine, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; 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.