NPIMap

Organization Active NPI

Dental 360 Kenosha

  • General Practice Dentistry
  • Kenosha, WI
National Provider Identifier
1669199600
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL 360 KENOSHA
Practice address
3726 Roosevelt Rd
Kenosha, WI 53142-1900
Phone
(262) 652-7956
NPI assigned
Oct 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Authorized official

Name
Ivana Bueno
Title
Director
Phone
(773) 798-9382

Specialties & licenses 1

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

Addresses

Primary practice location

3726 Roosevelt Rd
Kenosha, WI 53142-1900

Mailing address

3726 Roosevelt Rd
Kenosha, WI 53142-1900

National Provider Directory

National Provider Directory

Locations

3726 Roosevelt Rd
Kenosha, WI 53142
Phone (262) 652-7956

Practitioners & affiliated clinicians

Practitioners 3

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": "1666224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1669199600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3726 ROOSEVELT RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531421900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 ROOSEVELT RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531421900",
            "telephone_number": "262-652-7956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL 360 KENOSHA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-20",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "BUENO",
        "authorized_official_first_name": "IVANA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "773-798-9382"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.