Active NPI
Brian Joseph Waldau, D.M.D.
- Dentist
- Mount Pleasant, WI
National Provider Identifier
1578624730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6617
- Practice address
- 1101 S Airline Rd
Mount Pleasant, WI 53406-3888 - Phone
- (262) 637-9371
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D8772 | OR | |
| Dentist | 122300000X | 6617 | WI | Primary |
Addresses
Primary practice location
1101 S Airline Rd
Mount Pleasant, WI 53406-3888
Mailing address
1101 S Airline Rd
Mount Pleasant, WI 53406-3888
Phone (262) 637-9371
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Jun 26, 2018 through Jun 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8772 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Racine Dental Center LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Racine, WI
- NPI 1932814670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536710400000",
"number": "1578624730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 S AIRLINE RD",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534063888",
"telephone_number": "262-637-9371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 S AIRLINE RD",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534063888",
"telephone_number": "262-637-9371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDAU",
"first_name": "BRIAN",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2018-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D8772",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, WI
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- Kelly G. Von-Schilling Worth, DC, FIACN, DACAN
- Maria-Gretchen Fabroa Wagner-Richardson, RN
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2668)
- Wal-Mart Stores East LP (WalMart Pharmacy 10-5695)
- Sandra Lynn Waldvogel, COTA
- Walgreen
- Walgreen Co (Walgreens #09606)
- Walgreen Co (Walgreens #05417)
- Terri Lee Wallow, SACIT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.