Michelle Lynn Dematthew, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1002314 Issued in WI

Practice address

6729 Lake Rd
Windsor, WI 53598

Phone

(608) 846-5407

NPI assigned

May 26, 2020

Last updated

Sep 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Michelle Lynn Zellmer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Dematthew Dental, LLC

  • Dental Clinic/Center
  • Windsor, WI
  • NPI 1447128228
  NPD Authorized official

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

{
    "created_epoch": "1590451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1790308666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 N WATER ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532022793",
            "telephone_number": "414-791-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6729 LAKE RD",
            "city": "WINDSOR",
            "state": "WI",
            "postal_code": "53598",
            "telephone_number": "608-846-5407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMATTHEW",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-26",
        "last_updated": "2023-09-14",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "ZELLMER",
            "middle_name": "LYNN",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Toni Boegel, LPN
• Heather Marie Burdett, RN
• Philip R Carlson, MD
• Complete Mobile Dentistry, Inc
• Dematthew Dental, LLC
• Forward Health
• Katherine Geiser, LPC, CSAC
• Jacqueline L Gerhart, M.D.
• Leann Elizabeth Greuel, PA-C
• Gulf South Medical Supply

• General Practice Dentistry in Windsor, WI
• Providers in Windsor, 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 Sep 14, 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.