Willow Dental Group LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WILLOW DENTAL GROUP LLC

Practice address

3333 S Sunnyslope Rd Ste 100
New Berlin, WI 53151-4504

Phone

(262) 505-1000

NPI assigned

Jun 30, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Nicholas Dwan, DDSNPI 1255718169

Title

General Dentist

Phone

(262) 505-1000

Specialties & licenses 1

Addresses

Other names 1

• Willow Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicholas Dwan, D.D.S.

  • General Practice Dentistry
  • New Berlin, WI
  • NPI 1255718169
  NPD Authorized official

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593475200000",
    "number": "1609493188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 S SUNNYSLOPE RD STE 100",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531514504",
            "telephone_number": "262-505-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 S SUNNYSLOPE RD STE 100",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531514504",
            "telephone_number": "262-505-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-30",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A",
        "authorized_official_last_name": "DWAN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "262-505-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Ann Willan
• Katie Anne Willcockson, M.D.
• Robert E Williams, MD
• Tia L Williams
• Kayla Christine Williamson, LCSW
• Jeffrey D. Winkoski, M.D.
• Wisconsin CVS Pharmacy LLC
• Wisconsin Dental Group, S.C.
• Wisconsin Vision, LLC
• Mary Kae Wisinski, P.T.

• Dental Clinic/Center in New Berlin, WI
• Providers in New Berlin, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.