NPIMap

Organization Active NPI

Dr. Mary Grote

  • Oral and Maxillofacial Surgery (Dentist)
  • Beaver Dam, WI
National Provider Identifier
1740336114
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2582-015 Issued in WI
Legal business name
DR. MARY GROTE
Practice address
301 S Roosevelt Dr
Suite a
Beaver Dam, WI 53916-2439
Phone
(920) 887-8423
Fax
(920) 887-8471
NPI assigned
Jan 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mary Grote, DDS
Title
Owner
Phone
(920) 887-8423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 2582-015 WI Primary

Addresses

Primary practice location

301 S Roosevelt Dr
Suite a
Beaver Dam, WI 53916-2439

Mailing address

301 S Roosevelt Dr
Suite a
Beaver Dam, WI 53916-2439
Phone (920) 887-8423

National Provider Directory

National Provider Directory

Locations

301 S Roosevelt Dr
Ste A
Beaver Dam, WI 53916
Phone (920) 887-8423

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740336114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S ROOSEVELT DR",
            "address_2": "SUITE A",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162439",
            "telephone_number": "920-887-8423",
            "fax_number": "920-887-8471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S ROOSEVELT DR",
            "address_2": "SUITE A",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162439",
            "telephone_number": "920-887-8423",
            "fax_number": "920-887-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MARY GROTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GROTE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-887-8423",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "2582-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.