NPIMap

Organization Active NPI

Peerenboom Dental LLC

  • Dentist
  • Wausau, WI
National Provider Identifier
1558837658
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PEERENBOOM DENTAL LLC
Practice address
1 Corporate Dr Ste 100
Wausau, WI 54401-1724
Phone
(608) 833-2213
NPI assigned
Oct 17, 2018
Last updated
Oct 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Authorized official

Name
Olga Grenova
Title
Dir of Accounting
Phone
(608) 833-2213

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1 Corporate Dr Ste 100
Wausau, WI 54401-1724

Mailing address

8025 Excelsior Dr
Madison, WI 53717-1900
Phone (608) 833-2213

National Provider Directory

National Provider Directory

Locations

1 Corporate Dr
Ste 100
Wausau, WI 54401
Phone (608) 833-2213

NPI Registry JSON

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539734400000",
    "number": "1558837658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8025 EXCELSIOR DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171900",
            "telephone_number": "608-833-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CORPORATE DR STE 100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544011724",
            "telephone_number": "608-833-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEERENBOOM DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "GRENOVA",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "DIR OF ACCOUNTING",
        "authorized_official_telephone_number": "608-833-2213"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; 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.