David Charles Utrie, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5002046 Issued in WI

Practice address

105 N Lincoln Ave
Beaver Dam, WI 53916-2140

Phone

(920) 887-2427

Fax

(920) 887-2907

NPI assigned

Jul 17, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1629095278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N LINCOLN AVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162140",
            "telephone_number": "920-887-2427",
            "fax_number": "920-887-2907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N LINCOLN AVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162140",
            "telephone_number": "920-887-2427",
            "fax_number": "920-887-2907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTRIE",
        "first_name": "DAVID",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5002046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33376200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Beaver Dam, WI
• Providers in Beaver Dam, 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 Jul 9, 2007; 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.