Mt Calvary Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MT CALVARY DENTAL LLC

Practice address

100 Evergreen Rd
Mount Calvary, WI 53057-9726

Phone

(920) 753-2771

NPI assigned

Nov 28, 2020

Last updated

Nov 28, 2020By 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

Dr. Caitlin Bloomer, DDSNPI 1457845133

Title

Owner/Dentist

Phone

(920) 645-1219

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Caitlin Bloomer, DDS

  • General Practice Dentistry
  • New Holstein, WI
  • NPI 1457845133
  NPD Authorized official

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

{
    "created_epoch": "1606521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606521600000",
    "number": "1780288977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 WOODVIEW LN",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530801400",
            "telephone_number": "920-645-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EVERGREEN RD",
            "city": "MOUNT CALVARY",
            "state": "WI",
            "postal_code": "530579726",
            "telephone_number": "920-753-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT CALVARY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-28",
        "last_updated": "2020-11-28",
        "certification_date": "2020-11-28",
        "status": "A",
        "authorized_official_last_name": "BLOOMER",
        "authorized_official_first_name": "CAITLIN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "920-645-1219",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Agnesian Healthcare (Fond Du Lac Regional Clinic)
• Consultants Laboratory of Wisconsin, LLC
• Adam Joseph Jodocy
• Mount Calvary Ambulance Service Inc
• Stephanie Ann Schumacher
• Sister Servants of Christ the King Inc (Villa Loretto)
• Angela Lynn Steffes, R.N.
• Jeffrey A Strong, MD
• Maria Therese Weeks, MS, MA, LPC-IT

• Dental Clinic/Center in Mount Calvary, WI
• Providers in Mount Calvary, 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 Nov 28, 2020; 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.