David Richard Brostowitz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0003170 Issued in WI

Practice address

141 W Front St
Peshtigo, WI 54157-1421

Phone

(715) 582-3601

NPI assigned

Mar 30, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• David R. Brostowitz, DDS, SC

  • General Practice Dentistry
  • Peshtigo, WI
  • NPI 1780704981
  NPD (past) Authorized official

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1679693840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W FRONT ST",
            "city": "PESHTIGO",
            "state": "WI",
            "postal_code": "541571421",
            "telephone_number": "715-582-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W FRONT ST",
            "city": "PESHTIGO",
            "state": "WI",
            "postal_code": "541571421",
            "telephone_number": "715-582-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROSTOWITZ",
        "first_name": "DAVID",
        "middle_name": "RICHARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "0003170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33452900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benzer Wi 2 LLC (Peshtigo Pharmacy)
• Penny Lynn Berken, LPN
• Kelly Boehm
• Jacqueline Ann Boice, RDH
• Brian M Thielen (Thielen Family Dental)
• Joseph Brostowitz
• Tiffany C. Cash, D.M.D.
• Brynn Crawley
• Rhonda Lynn Cumicek, APNP
• Mary Dahl, R.N.

• General Practice Dentistry in Peshtigo, WI
• Providers in Peshtigo, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.