NPIMap

Organization Active NPI

Antisdel Dental Clinic, S.C.

  • General Practice Dentistry
  • Saukville, WI
National Provider Identifier
1649294257
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2485-015 / 2486-015 Issued in WI
Legal business name
ANTISDEL DENTAL CLINIC, S.C.
Practice address
661 E Green Bay Ave
Saukville, WI 53080-2013
Phone
(262) 284-7111
Fax
(262) 284-1172
NPI assigned
Jul 27, 2006
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
Dr. Robert James Antisdel, D.D.S.NPI 1558586370
Title
President / Dentist
Phone
(262) 284-7111

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 2485-015 / 2486-015 WI Primary

Addresses

Primary practice location

661 E Green Bay Ave
Saukville, WI 53080-2013

Mailing address

661 E Green Bay Ave
Saukville, WI 53080-2013
Phone (262) 284-7111

National Provider Directory

National Provider Directory

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": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649294257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802013",
            "telephone_number": "262-284-7111",
            "fax_number": "262-284-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802013",
            "telephone_number": "262-284-7111",
            "fax_number": "262-284-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTISDEL DENTAL CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANTISDEL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT / DENTIST",
        "authorized_official_telephone_number": "12622847111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2485-015 / 2486-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saukville, 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.