Active NPI
Maxwell Miguel Mindiola, DDS
- Dentist
- Janesville, WI
National Provider Identifier
1619718293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6001541-15
- Practice address
- 2630 Liberty LN
Janesville, WI 53545-0717 - Phone
- (608) 752-2931
- NPI assigned
- Jun 5, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6001541-15 | WI | Primary |
Addresses
Primary practice location
2630 Liberty LN
Janesville, WI 53545-0717
Mailing address
5909 Sharpsburg Dr Apt 504
Madison, WI 53718-3052
Phone (262) 470-6948
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001541-15 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717545600000",
"number": "1619718293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5909 SHARPSBURG DR APT 504",
"city": "MADISON",
"state": "WI",
"postal_code": "537183052",
"telephone_number": "262-470-6948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2630 LIBERTY LN",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535450717",
"telephone_number": "608-752-2931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINDIOLA",
"first_name": "MAXWELL",
"middle_name": "MIGUEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-05",
"last_updated": "2024-06-05",
"certification_date": "2024-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6001541-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Janesville, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.