NPIMap

Organization Active NPI

Menomonie Street Dental

  • General Practice Dentistry
  • Eau Claire, WI
National Provider Identifier
1689746851
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MENOMONIE STREET DENTAL
Practice address
1020 Menomonie St
Eau Claire, WI 54703-5952
Phone
(715) 834-8161
Fax
(715) 834-6272
NPI assigned
Nov 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Maria Ann Hanke
Title
Insurance Coordinator
Phone
(715) 834-8161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X WI Primary

Addresses

Primary practice location

1020 Menomonie St
Eau Claire, WI 54703-5952

Mailing address

1020 Menomonie St
Eau Claire, WI 54703-5952
Phone (715) 834-8161

Other identifiers 1

IdentifierTypeStateIssuer
38355800MedicaidWI

National Provider Directory

National Provider Directory

Locations

1020 Menomonie St
Eau Claire, WI 54703
Phone (715) 834-8161

Practitioners & affiliated clinicians

Practitioners 8

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689746851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 MENOMONIE ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547035952",
            "telephone_number": "715-834-8161",
            "fax_number": "715-834-6272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 MENOMONIE ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547035952",
            "telephone_number": "715-834-8161",
            "fax_number": "715-834-6272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENOMONIE STREET DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANKE",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "715-834-8161"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38355800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eau Claire, 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.