Wisconsin Dental Partners, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WISCONSIN DENTAL PARTNERS, LLC

Doing business as

The Country Dentist

Practice address

340 Main St
Darlington, WI 53530-1426

Phone

(608) 776-2620

Fax

(608) 776-3988

NPI assigned

Jan 7, 2016

Last updated

Jan 7, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Andrew T Fabian

Title

Manager

Phone

(608) 712-6320

Specialties & licenses 1

Addresses

Other names 1

• The Country Dentist Doing business as

Locations

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452124800000",
    "number": "1750747739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6907 UNIVERSITY AVE",
            "address_2": "SUITE 405",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535622767",
            "telephone_number": "608-712-6320",
            "fax_number": "608-338-0681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MAIN ST",
            "city": "DARLINGTON",
            "state": "WI",
            "postal_code": "535301426",
            "telephone_number": "608-776-2620",
            "fax_number": "608-776-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN DENTAL PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-07",
        "last_updated": "2016-01-07",
        "status": "A",
        "authorized_official_last_name": "FABIAN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "608-712-6320",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Country Dentist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daisy Wiegel
• Bradley R Willborn, BS, MSE
• Melanie Willborn, CSW-BS
• Jeanette Williams, APNP, PMHNP-BC
• Melissa Wirtz, SW
• Ashley L Withrow, BS
• Cheri L Wotnoske, CSAC
• Venkata Yearva, M.D.
• Molly Anne Zuehlke, B.S. R.N.

• Dental Clinic/Center in Darlington, WI
• Providers in Darlington, 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 Jan 7, 2016; 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.