NPIMap

Organization Active NPI

Ultimate Dental Care

  • Health Maintenance Organization
  • Racine, WI
National Provider Identifier
1679941447
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
7001-15 Issued in WI
Legal business name
ULTIMATE DENTAL CARE
Practice address
4915 Washington Ave
Suite B
Racine, WI 53406-4221
Phone
(262) 619-1949
NPI assigned
Sep 9, 2015
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
Dr. Houssam Elchekha, DDS
Title
Owner
Phone
(573) 639-0256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 7001-15 WI Primary

Addresses

Primary practice location

4915 Washington Ave
Suite B
Racine, WI 53406-4221

Mailing address

4915 Washington Ave
Suite B
Racine, WI 53406-4221
Phone (262) 619-1949

National Provider Directory

National Provider Directory

Locations

4915 Washington Ave
Ste B
Racine, WI 53406
Phone (262) 619-1949

NPI Registry JSON

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1679941447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 WASHINGTON AVE",
            "address_2": "SUITE B",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534064221",
            "telephone_number": "262-619-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 WASHINGTON AVE",
            "address_2": "SUITE B",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534064221",
            "telephone_number": "262-619-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "ELCHEKHA",
        "authorized_official_first_name": "HOUSSAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-639-0256",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "WI",
            "license": "7001-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, 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.