Glendale Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

6886 Issued in WI

Legal business name

GLENDALE DENTAL LLC

Practice address

5150 N Port Washington Rd Ste 201
Glendale, WI 53217-5400

Phone

(414) 964-8850

Fax

(414) 964-8918

NPI assigned

May 29, 2018

Organization subpart

No

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

Authorized official

Name

Christopher Potrykus, DDS

Title

Owner

Phone

(262) 646-2771

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527552000000",
    "number": "1710478557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 INDIAN SPRING DR",
            "city": "DELAFIELD",
            "state": "WI",
            "postal_code": "530182242",
            "telephone_number": "262-873-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD STE 201",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175400",
            "telephone_number": "414-964-8850",
            "fax_number": "414-964-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-29",
        "last_updated": "2018-05-29",
        "status": "A",
        "authorized_official_last_name": "POTRYKUS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-646-2771",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": "6886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Glendale, WI
• Providers in Glendale, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.