NPIMap

Organization Active NPI

Grandview Dental S.C.

  • General Practice Dentistry
  • Hudson, WI
National Provider Identifier
1639202013
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4584 Issued in WI
Legal business name
GRANDVIEW DENTAL S.C.
Practice address
900 Crestview Dr
Suite 240
Hudson, WI 54016-9517
Phone
(715) 381-5556
Fax
(715) 381-5355
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Patrick Lee Wolfe, D.D.S.NPI 1023266483
Title
President and Dentist
Phone
(715) 381-5556

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4584 WI Primary

Addresses

Primary practice location

900 Crestview Dr
Suite 240
Hudson, WI 54016-9517

Mailing address

900 Crestview Drive
Suite 240
Hudson, WI 54016-9517
Phone (715) 381-5556

Other identifiers 1

IdentifierTypeStateIssuer
33723000MedicaidWI

National Provider Directory

National Provider Directory

Locations

900 Crest View Dr
Ste 240
Hudson, WI 54016
Phone (715) 381-5556

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639202013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CRESTVIEW DRIVE",
            "address_2": "SUITE 240",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169517",
            "telephone_number": "715-381-5556",
            "fax_number": "715-381-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CRESTVIEW DR",
            "address_2": "SUITE 240",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169517",
            "telephone_number": "715-381-5556",
            "fax_number": "715-381-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDVIEW DENTAL S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOLFE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT AND DENTIST",
        "authorized_official_telephone_number": "715-381-5556",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33723000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.