South Side Guadalupe Dental Clinic Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTH SIDE GUADALUPE DENTAL CLINIC INC

Practice address

1112 S 3Rd St
Milwaukee, WI 53204-2413

Phone

(414) 643-8787

Fax

(414) 643-9725

NPI assigned

May 21, 2008

Last updated

May 21, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Maria Leticia Monje

Title

Clinic Manager

Phone

(414) 643-8787

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1598922122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 S 3RD ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042413",
            "telephone_number": "414-643-8787",
            "fax_number": "414-643-9725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 S 3RD ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042413",
            "telephone_number": "414-643-8787",
            "fax_number": "414-643-9725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SIDE GUADALUPE DENTAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "MONJE",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "LETICIA",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "414-643-8787",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38371500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Soung
• Paula Jean Soung, MD
• Brooke Jean Fails Soupenne, ED.S.
• Eugenia Maria Sousa, CSAC, NO 1909-132
• South Center Medical Group LTD
• James South, LPC-IT, M.S., PH.D.
• Southeast Surgical, S.C.
• Southeastern Family Practice SC
• Southeastern Pediatric & Adolescent Medicine, S.C. (Southeastern Pediatric & Adolescent Medicine)
• Southern Home Health

• General Practice Dentistry in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.