Gaurav Jain, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

1001303-15 Issued in WI

Practice address

N6571 Lumberjack Guy Rd
Marshfield Clinic Dental Center
Black River Falls, WI 54615-5405

Phone

(715) 387-5511

NPI assigned

Mar 4, 2016

Last updated

Aug 15, 2024By 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

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

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.

• Blue Lake Smiles

  dba Blue Lake Smiles Pediatric Dentistry

  • Pediatric Dentistry
  • Fond Du Lac, WI
  • NPI 1598627820
  NPD Authorized official
• Family Health Center of Marshfield Inc

  dba Family Health Center - Wisconsin Rapids Alcohol & Drug Recovery Center

  • Federally Qualified Health Center (FQHC)
  • Wisconsin Rapids, WI
  • NPI 1679447569
  NPD (past)

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

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1548620453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 N SAINT JOSEPH AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544491340",
            "telephone_number": "715-898-6208",
            "fax_number": "715-221-5688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N6571 LUMBERJACK GUY RD",
            "address_2": "MARSHFIELD CLINIC DENTAL CENTER",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546155405",
            "telephone_number": "715-387-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "GAURAV",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-04",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "1001303-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Pine View Healthcare, LLC (Pine View Nursing Home)
• Danielle B Jacobs, LCSW
• Dawn Cynthia Jacobson, MA, ATC, NASM-CES
• Patricia A Jacobson, APNP
• Serena Jahnke-Berg
• Ashley Virginia Ann Jakel, MSW, LCSW, SAC-IT
• Carol Ann Jarrett
• Jessica Elizabeth Jennings, R.D.
• Kelli Marie Jerdet Engen, RN, BSN
• Heather Jerzak, RD, CD

• Pediatric Dentistry in Black River Falls, WI
• Providers in Black River Falls, WI by specialty
• Pediatric Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.