Alan J. Domeyer, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6541-15 Issued in WI

Practice address

238 Front St
Cashton, WI 54619-2002

Phone

(608) 654-5100

NPI assigned

Jul 8, 2010

Last updated

Nov 23, 2015By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 16, 2017 through Nov 16, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sparta Family Dentistry, LLC

  • General Practice Dentistry
  • Sparta, WI
  • NPI 1811354194
  NPD (past) Authorized official

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448236800000",
    "number": "1770895567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 FRONT ST",
            "city": "CASHTON",
            "state": "WI",
            "postal_code": "546192002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 FRONT ST",
            "city": "CASHTON",
            "state": "WI",
            "postal_code": "546192002",
            "telephone_number": "608-654-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMEYER",
        "first_name": "ALAN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2015-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6541-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karyn Cecele, M.D.
• Danielle Ann Dale, RDH
• Hana Advincula Del Pilar, DMD
• Candace Melonie Demoran, RDH
• Melissa Ann Deyo, RDH
• Jacinda Eskander Edgar, DMD
• Pene Lee Enchante, D.C., DICCP
• Sara Ellen Freedman, FNP
• Julie Graf Domeyer, DDS
• Ahmed Ashraf Halawa, DMD

• General Practice Dentistry in Cashton, WI
• Providers in Cashton, 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 Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.