NPIMap

Organization Active NPI

Eastbrook Dental

  • General Practice Dentistry
  • Brookfield, WI
National Provider Identifier
1669518213
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5863 Issued in WI
Legal business name
EASTBROOK DENTAL
Practice address
12660 W North Ave
Brookfield, WI 53005-4633
Phone
(262) 796-1312
Fax
(262) 796-1318
NPI assigned
Jan 30, 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
Thomas R Henschel, D.D.S.NPI 1225174857
Title
President
Phone
(262) 796-1312

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 3324 WI
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 5863 WI Primary

Addresses

Primary practice location

12660 W North Ave
Brookfield, WI 53005-4633

Mailing address

12660 W North Ave
Brookfield, WI 53005-4633
Phone (262) 796-1312

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669518213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12660 W NORTH AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054633",
            "telephone_number": "262-796-1312",
            "fax_number": "262-796-1318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12660 W NORTH AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054633",
            "telephone_number": "262-796-1312",
            "fax_number": "262-796-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTBROOK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENSCHEL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-796-1312",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3324",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, 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.