NPIMap

Organization Active NPI

Winneconne Family Dentistry

  • General Practice Dentistry
  • Winneconne, WI
National Provider Identifier
1760728166
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5471 Issued in WI
Legal business name
WINNECONNE FAMILY DENTISTRY
Practice address
902 E Main St
Winneconne, WI 54986-9782
Phone
(920) 582-4427
Fax
(920) 582-7563
NPI assigned
Dec 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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

Authorized official

Name
Dr. Ryan Joseph Gonzalez, D.D.SNPI 1497725063
Title
President
Phone
(414) 202-9184

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5471 WI Primary

Addresses

Primary practice location

902 E Main St
Winneconne, WI 54986-9782

Mailing address

4668 W Woodland Dr
Franklin, WI 53132-8014

National Provider Directory

National Provider Directory

Locations

902 E Main St
Winneconne, WI 54986
Phone (920) 229-7092

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1760728166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4668 W WOODLAND DR",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "531328014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 E MAIN ST",
            "city": "WINNECONNE",
            "state": "WI",
            "postal_code": "549869782",
            "telephone_number": "920-582-4427",
            "fax_number": "920-582-7563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINNECONNE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-202-9184",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winneconne, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; 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.