Active NPI
Kevin T Ladesic, DDS
- Dentist
- West Salem, WI
National Provider Identifier
1669537924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5788
- Practice address
- 1403 Waterloo Ave
West Salem, WI 54669 - Phone
- (608) 786-0909
- Fax
- (608) 786-4999
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5788-015 | WI | |
| Dentist | 122300000X | 5788 | WI | Primary |
Addresses
Primary practice location
1403 Waterloo Ave
West Salem, WI 54669
Mailing address
1403 Waterloo Ave
West Salem, WI 54669
Phone (608) 786-0909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5788-015 | WI | MD | Dentist |
| 5788 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Geneva Dental Care LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Lake Geneva, WI
- NPI 1083732101
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242950400000",
"number": "1669537924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1403 WATERLOO AVE",
"city": "WEST SALEM",
"state": "WI",
"postal_code": "54669",
"telephone_number": "608-786-0909",
"fax_number": "608-786-4999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1403 WATERLOO AVE",
"city": "WEST SALEM",
"state": "WI",
"postal_code": "54669",
"telephone_number": "608-786-0909",
"fax_number": "608-786-4999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LADESIC",
"first_name": "KEVIN",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2009-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5788-015",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Salem, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.