Lake Country Dentistry, L.L.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAKE COUNTRY DENTISTRY, L.L.C.

Practice address

175 E Wisconsin Ave
Oconomowoc, WI 53066-3057

Phone

(262) 567-6003

Fax

(262) 567-6018

NPI assigned

May 9, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. James Jon Cotey

Title

General Manager

Phone

(262) 567-6003

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487868493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E WISCONSIN AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663057",
            "telephone_number": "262-567-6003",
            "fax_number": "262-567-6018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 E WISCONSIN AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663057",
            "telephone_number": "262-567-6003",
            "fax_number": "262-567-6018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY DENTISTRY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COTEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "262-567-6003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Kulpa, PHARMD
• Gerard L. Kupperman, PH.D.
• Lake Area Free Clinic
• Lake Country Birth LLC
• Lake Country Classical Academy, Inc.
• Lake Country Emergency Physicians
• Lake Country Endoscopy Center, LLC
• Lake Country Pain Treatment
• Lake Country Pediatrics SC (Lake Country Physicians)
• Lake Country Pharmacy

• Dental Clinic/Center in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Dental Clinic/Center in Wisconsin

• 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.