NPIMap

Organization Active NPI

Braden Dental Center SC

  • Dental Clinic/Center
  • Lake Geneva, WI
National Provider Identifier
1679793632
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
2499 Issued in WI
Legal business name
BRADEN DENTAL CENTER SC
Practice address
101 Broad St
Ste 203
Lake Geneva, WI 53147
Phone
(262) 248-0120
Fax
(262) 249-0140
NPI assigned
May 1, 2007
Last updated
Sep 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2015

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

Authorized official

Name
Mr. Mark Thomas Braden, DDSNPI 1780833475
Title
Owner of Braden Dental Center
Phone
(262) 248-0120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 2499 WI Primary

Addresses

Primary practice location

101 Broad St
Ste 203
Lake Geneva, WI 53147

Mailing address

101 Broad St
Ste 203
Lake Geneva, WI 53147
Phone (262) 248-0120

National Provider Directory

National Provider Directory

Locations

101 Broad St
Ste 203
Lake Geneva, WI 53147
Phone (262) 248-0120

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1679793632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BROAD ST",
            "address_2": "STE 203",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "53147",
            "telephone_number": "262-248-0120",
            "fax_number": "262-249-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BROAD ST",
            "address_2": "STE 203",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "53147",
            "telephone_number": "262-248-0120",
            "fax_number": "262-249-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADEN DENTAL CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "BRADEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER OF BRADEN DENTAL CENTER",
        "authorized_official_telephone_number": "262-248-0120",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": "2499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Geneva, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; 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.