Michael Jon Vitense, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

1722-G Issued in WI

Practice address

625 Walnut Ridge Dr Suite 102
Hartland, WI 53029

Phone

(262) 367-4255

Fax

(262) 367-4714

NPI assigned

Aug 22, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 21, 2016 through Jul 21, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Smith Dental West

  dba BarkRiver Dental Group

  • General Practice Dentistry
  • Hartland, WI
  • NPI 1003936279
  NPD (past)

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548376635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 WALNUT RIDGE DR SUITE 102",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "53029",
            "telephone_number": "262-367-4255",
            "fax_number": "262-367-4714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 WALNUT RIDGE DR SUITE 102",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "53029",
            "telephone_number": "262-367-4255",
            "fax_number": "262-367-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITENSE",
        "first_name": "MICHAEL",
        "middle_name": "JON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1722-G",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• University Lake School Inc
• Michael M. Uy, M.D.
• Rebecca Van de Laarschot
• Village of Hartland (Hartland Fire Department Rescue)
• Kaylyn Vinkavich, RN
• Nicole Wagner, M.S., CCC-SLP
• Walgreen Co (Walgreens #09365)
• Traci Wall, D.C.
• Madeline M Walter, DDS
• Kacie Estes Walters, D.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.