NPIMap

Organization Active NPI

Idental

  • Dental Hygienist
  • Mount Pleasant, WI
National Provider Identifier
1508316753
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
5279 Issued in WI
Legal business name
IDENTAL
Practice address
1320 S Green Bay Rd
Mount Pleasant, WI 53406-4402
Phone
(262) 223-0280
Fax
(262) 223-0281
NPI assigned
Oct 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Ms. Marian 'Tracie' Clubb
Title
Assistant Manager
Phone
(262) 223-0280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental HygienistGroup: 193400000X SINGLE SPECIALTY GROUP 124Q00000X 5279 WI Primary

Addresses

Primary practice location

1320 S Green Bay Rd
Mount Pleasant, WI 53406-4402

Mailing address

1320 S Green Bay Rd
Mount Pleasant, WI 53406-4402
Phone (262) 223-0280

National Provider Directory

National Provider Directory
Tax ID family
Idental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1508316753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 S GREEN BAY RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064402",
            "telephone_number": "262-223-0280",
            "fax_number": "262-223-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 S GREEN BAY RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064402",
            "telephone_number": "262-223-0280",
            "fax_number": "262-223-0281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "CLUBB",
        "authorized_official_first_name": "MARIAN",
        "authorized_official_middle_name": "'TRACIE'",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "262-223-0280",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Hygienist",
            "state": "WI",
            "license": "5279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; 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.