John Patrick Smith, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3790 Issued in WI

Practice address

1114 Ann St Ste 1-PO # 487
Delavan, WI 53115-1938

Phone

(262) 728-8232

Fax

(262) 728-8259

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191283200000",
    "number": "1700974136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 ANN ST STE 1-PO # 487",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531151938",
            "telephone_number": "262-728-8232",
            "fax_number": "262-728-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1114 ANN ST STE 1-PO # 487",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531151938",
            "telephone_number": "262-728-8232",
            "fax_number": "262-728-8259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOHN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33495800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mitchell Sherman, CPS
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• Vicki Lee Soderberg, LPN
• Joel Sperling, D.C.
• Kristen Spreitzer, BS
• Karen St John

• General Practice Dentistry in Delavan, WI
• Providers in Delavan, 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 Oct 2, 2007; 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.