NPIMap

Organization Active NPI

Prairie Lakes Dental

  • General Practice Dentistry
  • Sun Prairie, WI
National Provider Identifier
1609298595
Registry record updated Jan 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PRAIRIE LAKES DENTAL
Practice address
2804 Prairie Lakes Drive
Sun Prairie, WI 53590
Phone
(608) 825-3333
Fax
(608) 825-3444
NPI assigned
Jan 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2014

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

Authorized official

Name
Adam Forster
Title
President Owner Doctor
Phone
(920) 623-5559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2804 Prairie Lakes Drive
Sun Prairie, WI 53590

Mailing address

2804 Prairie Lakes Drive
Sun Prairie, WI 53590
Phone (608) 825-3333

National Provider Directory

National Provider Directory
Tax ID family
Columbus Family Dental Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1389312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389312000000",
    "number": "1609298595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 PRAIRIE LAKES DRIVE",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "53590",
            "telephone_number": "608-825-3333",
            "fax_number": "608-825-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 PRAIRIE LAKES DRIVE",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "53590",
            "telephone_number": "608-825-3333",
            "fax_number": "608-825-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE LAKES DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-10",
        "last_updated": "2014-01-10",
        "status": "A",
        "authorized_official_last_name": "FORSTER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT OWNER DOCTOR",
        "authorized_official_telephone_number": "920-623-5559"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun Prairie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; 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.