John Milton Dovorany, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

5000512015 Issued in WI

Practice address

1488 E Green Bay St
Shawano, WI 54166

Phone

(715) 524-8878

NPI assigned

Dec 18, 2006

Last updated

Oct 15, 2007By the provider in NPPES

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

State licenses

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192406400000",
    "number": "1740343086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1488 E GREEN BAY ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "54166",
            "telephone_number": "715-524-8878",
            "fax_number": "715-524-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1488 E GREEN BAY ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "54166",
            "telephone_number": "715-524-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOVORANY",
        "first_name": "JOHN",
        "middle_name": "MILTON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5000512015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33666700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Shawano, WI
• Providers in Shawano, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.