Sun Prairie Family Dentistry LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SUN PRAIRIE FAMILY DENTISTRY LLC

Practice address

180 Wilburn Rd
Sun Prairie, WI 53590-1476

Phone

(608) 833-2213

NPI assigned

Dec 1, 2019

Organization subpart

No

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

Authorized official

Name

Olga Grenova

Title

Dir of Accounting

Phone

(608) 833-2213

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1575158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575158400000",
    "number": "1730726555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8025 EXCELSIOR DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171900",
            "telephone_number": "608-833-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 WILBURN RD",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535901476",
            "telephone_number": "608-833-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN PRAIRIE FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-01",
        "last_updated": "2019-12-01",
        "status": "A",
        "authorized_official_last_name": "GRENOVA",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "DIR OF ACCOUNTING",
        "authorized_official_telephone_number": "608-833-2213"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli Stovall
• Randall Howard Straub, DDS
• Ellen J Sullivan, LCSW
• Kevin A. Sullivan, L.I.S.W.
• Sun Prairie Area School District
• Sun Prairie Health Care Center, LLC
• Sun Prairie Healthcare Operations, LLC
• Sun Prairie Hometown Pharmacy LLC
• Sun Prairie Laser Pain Center
• Sun Prairie Ops, LLC

• Dentist in Sun Prairie, WI
• Providers in Sun Prairie, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2019; 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.