Chad Goeke, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

1001300-15 Issued in WI

Practice address

W4173 County Road H
Fond Du Lac, WI 54937-9653

Phone

(815) 541-9561

NPI assigned

Jun 3, 2016

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

Enrolled in WI

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 and National Provider Directory roles.

• Fondy Family Dental

  • Dental Clinic/Center
  • Fond Du Lac, WI
  • NPI 1962099101
  NPD Authorized official

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1548619265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 CAMELOT DR",
            "address_2": "SUITE #3",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358048",
            "telephone_number": "920-921-1244",
            "fax_number": "920-921-2192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W4173 COUNTY ROAD H",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549379653",
            "telephone_number": "815-541-9561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOEKE",
        "first_name": "CHAD",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001300-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Kelly Gillett, OTR
• Donna Tina May Glissendorf, MSW, LCSW, CSAC
• Hiwot Ayalew Gobezie, MD
• David Michael Godshall, RPH
• Terrina Kay Goeden, APNP
• Shannon E Goeke, DPT
• Golden High LLC
• Nancy L Goranson, PHD
• Timothy Gorges, PT
• Elizabeth A Gorman, MS CCC-A

• Dentist in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.