Individual provider Active NPI

John L Felkner, DDS

  • General Practice Dentistry
  • Weston, WI
National Provider Identifier
1710016167
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5001554 Issued in WI
Practice address
5702 Memorial CT
Weston, WI 54476-6502
Phone
(715) 355-1717
NPI assigned
Mar 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5001554 WI Primary

Addresses

Primary practice location

5702 Memorial CT
Weston, WI 54476-6502

Mailing address

3326 N 12TH St
Wausau, WI 54403-2314
Phone (715) 842-1979

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160104000923 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9739481029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5001554WIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1172880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710016167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 N 12TH ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544032314",
            "telephone_number": "715-842-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5702 MEMORIAL CT",
            "city": "WESTON",
            "state": "WI",
            "postal_code": "544766502",
            "telephone_number": "715-355-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELKNER",
        "first_name": "JOHN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weston, WI

Sources for this page

Verify at the official NPI Registry.