Pack Janesville Dental, LLC.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5001352 Issued in WI

Legal business name

PACK JANESVILLE DENTAL, LLC.

Practice address

3131 Milton Ave Ste 190
Janesville, WI 53545-0244

Phone

(608) 302-4444

Fax

(608) 754-4436

NPI assigned

Jan 19, 2015

Organization subpart

No

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

Authorized official

Name

Kim Van Camp

Title

Provider Relations Specialist

Phone

(315) 464-6000

Specialties & licenses 1

Addresses

Other names 1

• Aspen Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nausheen Pearl Daniel, DMD

  • Dentist
  • Janesville, WI
  • NPI 1740175728
  NPD (past)

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

{
    "created_epoch": "1421625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421625600000",
    "number": "1740679448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "866-273-8204",
            "fax_number": "866-803-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 MILTON AVE STE 190",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535450244",
            "telephone_number": "608-302-4444",
            "fax_number": "608-754-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACK JANESVILLE DENTAL, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-19",
        "last_updated": "2015-01-19",
        "status": "A",
        "authorized_official_last_name": "VAN CAMP",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SPECIALIST",
        "authorized_official_telephone_number": "315-464-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dayna C Osborne, APNP
• Erin Shea Osborne
• Tamar Osborne, PT
• Manuella Dany Oulabou, RDH
• Victoria Anne Ourada, MS CCC-SLP
• Kristen Paeth, LCSW
• Carolyn Elaine Pagel
• Hariharan Palayapalayam Ganapathi, MD
• Douglas R Palmer, MD
• Susan Louese Paras, SLP

• General Practice Dentistry in Janesville, WI
• Providers in Janesville, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2015; 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.