NPIMap

Organization Active NPI

LTC Dental II LLC

  • Dentist
  • St Francis, WI
National Provider Identifier
1780341099
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
LTC DENTAL II LLC
Practice address
4060 S Lake Dr Apt 4
Saint Francis, WI 53235-5256
Phone
(407) 375-3003
Fax
(800) 863-5373
NPI assigned
Nov 22, 2021
Last updated
Nov 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Authorized official

Name
Tara RobinsonNPI 1609478585
Title
Chief Execute Officer
Phone
(407) 375-3003

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary
Dental Hygienist 124Q00000X NU

Addresses

Primary practice location

4060 S Lake Dr Apt 4
Saint Francis, WI 53235-5256

Mailing address

4060 S Lake Dr Apt 4
Saint Francis, WI 53235-5256
Phone (407) 375-3003

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637539200000",
    "number": "1780341099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 S LAKE DR APT 4",
            "city": "SAINT FRANCIS",
            "state": "WI",
            "postal_code": "532355256",
            "telephone_number": "407-375-3003",
            "fax_number": "800-863-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 S LAKE DR APT 4",
            "city": "SAINT FRANCIS",
            "state": "WI",
            "postal_code": "532355256",
            "telephone_number": "407-375-3003",
            "fax_number": "800-863-5373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC DENTAL II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "CHIEF EXECUTE OFFICER",
        "authorized_official_telephone_number": "407-375-3003"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Francis, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.