Family Dental Center, SC

Primary specialty

DentistTaxonomy code 122300000X

License

3890 Issued in WI

Legal business name

FAMILY DENTAL CENTER, SC

Practice address

3712 Kadow St
Manitowoc, WI 54220-5450

Phone

(920) 684-8033

Fax

(920) 684-6360

NPI assigned

Nov 29, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathy Ellen Seidl

Title

Business Assistant

Phone

(920) 684-8033

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elise Borja, DDS

  • General Practice Dentistry
  • Manitowoc, WI
  • NPI 1508329921
  NPD (past)
• Ronald Egan, DDS

  • General Practice Dentistry
  • Manitowoc, WI
  • NPI 1588685028
  NPD (past)
• Lukas Anthony Tenuta

  • General Practice Dentistry
  • Manitowoc, WI
  • NPI 1003747353
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639246127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3712 KADOW ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542205450",
            "telephone_number": "920-684-8033",
            "fax_number": "920-684-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3712 KADOW ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542205450",
            "telephone_number": "920-684-8033",
            "fax_number": "920-684-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL CENTER, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SEIDL",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "BUSINESS ASSISTANT",
        "authorized_official_telephone_number": "920-684-8033"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "3890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38393000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Allen Ericson, PTA
• Jody Lee Erlicher, LPC
• Louise Euclide
• Eye Clinic of Manitowoc, S.C.
• Eyemart Express LLC
• Stephanie Farr
• Velislava Fatchikova, PHARMD
• Patrick Feldmann
• Kaylee Kiilani Fernandez, RN
• Katherine Figurin, CCC

• Dentist in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Dentist in Wisconsin

• 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.