Complete Mobile Dentistry, Inc

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

COMPLETE MOBILE DENTISTRY, INC

Practice address

4300 Duraform LN
Windsor, WI 53598-9671

Phone

(608) 217-4536

NPI assigned

Aug 23, 2023

Organization subpart

No

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

Authorized official

Name

Lisa Ann Hartig

Title

Owner

Phone

(608) 217-4536

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1780468397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 DURAFORM LN",
            "city": "WINDSOR",
            "state": "WI",
            "postal_code": "535989671",
            "telephone_number": "608-217-4536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 DURAFORM LN",
            "city": "WINDSOR",
            "state": "WI",
            "postal_code": "535989671",
            "telephone_number": "608-217-4536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE MOBILE DENTISTRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "HARTIG",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-217-4536"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Marie Bell, D.D.S.
• Demonterryo L Black Sr., DO
• Toni Boegel, LPN
• Heather Marie Burdett, RN
• Philip R Carlson, MD
• Dematthew Dental, LLC
• Michelle Lynn Dematthew, DDS
• Forward Health
• Katherine Geiser, LPC, CSAC
• Jacqueline L Gerhart, M.D.

• All providers in Windsor, WI
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.