NPIMap

Organization Active NPI

John B. Dewolf, III, D.M.D., S.C.

  • Dentist
  • Clintonville, WI
National Provider Identifier
1699899336
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2919 Issued in WI
Legal business name
JOHN B. DEWOLF, III, D.M.D., S.C.
Doing business as
Clintonville Family Dentistry
Practice address
112 S Main St
Clintonville, WI 54929-1631
Phone
(715) 823-2233
Fax
(715) 823-5720
NPI assigned
Mar 19, 2007
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
Dr. John Dewolf III, D.M.D.NPI 1033219290
Title
President
Phone
(715) 823-2233

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2919 WI Primary

Addresses

Primary practice location

112 S Main St
Clintonville, WI 54929-1631

Mailing address

112 S Main St
Clintonville, WI 54929-1631
Phone (715) 823-2233

Other names 1

  • Clintonville Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

112 S Main St
Clintonville, WI 54929
Phone (715) 823-2233

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699899336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 S MAIN ST",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549291631",
            "telephone_number": "715-823-2233",
            "fax_number": "715-823-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 S MAIN ST",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549291631",
            "telephone_number": "715-823-2233",
            "fax_number": "715-823-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN B. DEWOLF, III, D.M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEWOLF",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-823-2233",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "2919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clintonville Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clintonville, 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.