Modern Dental Center Oshkosh LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MODERN DENTAL CENTER OSHKOSH LLC

Practice address

1795 W Pointe Dr
Oshkosh, WI 54902-4297

Phone

(920) 235-6453

NPI assigned

Feb 25, 2022

Last updated

Jul 21, 2026By 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

Victoria Johnson

Title

Cro

Phone

(941) 444-0558

Specialties & licenses 1

Addresses

Other names 1

• Dental Care Alliance Other name

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andreas Juerg Baltzly, DDS

  • Dentist
  • Massillon, OH
  • NPI 1275010654
  NPD
• Michael Gerard Bell, D.D.S.

  • General Practice Dentistry
  • Oshkosh, WI
  • NPI 1174642383
  NPD (past)
• Kurt A Walejko, D.D.S.

  • Dentist
  • Oshkosh, WI
  • NPI 1821378803
  NPD (past)

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

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1538815733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1795 W POINTE DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549024297",
            "telephone_number": "920-235-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 W POINTE DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549024297",
            "telephone_number": "920-235-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL CENTER OSHKOSH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-25",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "941-444-0558"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Care Alliance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tamara Sue Mischka, AU.D., CCC-A
• Marina V Mishin, PA-C
• Luke Mittelstaedt
• Thomas Mittelsteadt, SAC
• Jennifer Mladucky, NP
• Carrie L Moenk, RD
• Muhammad I Moid, MD
• Laurie Mollenhauer, P.T., D.P.T.
• Jill Kristine Monroe, RN RCS
• Helen A Moore, RN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; 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.