Maxwell Reisner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6000027-15 Issued in WI

Practice address

912 24 1/2 St
Chetek, WI 54728-7925

Phone

(715) 859-2202

NPI assigned

Apr 5, 2022

Last updated

Jun 20, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1700527488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 24 1/2 ST",
            "city": "CHETEK",
            "state": "WI",
            "postal_code": "547287925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 24 1/2 ST",
            "city": "CHETEK",
            "state": "WI",
            "postal_code": "547287925",
            "telephone_number": "715-859-2202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532332186",
            "country_code": "US",
            "telephone_number": "715-642-0274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REISNER",
        "first_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6000027-15",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey M Marquardt, MD
• Charles Mikow, PAC
• Diana Odagard
• Outback Chiropractic LLC
• Pharmacare LTD (Ohde Health Mart Pharmacy)
• Deanne Ruppel, CHC
• Sather Family Dental, LLC
• Nik Edward Sather, D.D.S.
• Sharon Ann Schumacher, P.T.
• Trevor Secraw, D.C.

• General Practice Dentistry in Chetek, WI
• Providers in Chetek, 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 Jun 20, 2022; 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.