Waushara Dental Associate SC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WAUSHARA DENTAL ASSOCIATE SC

Practice address

322 Broadway
Berlin, WI 54923

Phone

(920) 361-3800

NPI assigned

Oct 24, 2014

Last updated

Oct 24, 2014By 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

Darren Stelter

Title

President

Phone

(920) 361-3800

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414108800000",
    "number": "1760887392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 BROADWAY",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "54923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 BROADWAY",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "54923",
            "telephone_number": "920-361-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUSHARA DENTAL ASSOCIATE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-24",
        "last_updated": "2014-10-24",
        "status": "A",
        "authorized_official_last_name": "STELTER",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-361-3800"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Berlin, WI
• Providers in Berlin, 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 Oct 24, 2014; 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.