NPIMap

Organization Active NPI

Black River Falls Dental LLC

Doing business as Black River Family Dentistry

  • Dentist
  • Black River Falls, WI
National Provider Identifier
1790393270
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
BLACK RIVER FALLS DENTAL LLC
Doing business as
Black River Family Dentistry
Practice address
N6625 County Road a
Black River Falls, WI 54615-5852
Phone
(715) 284-3100
NPI assigned
Jul 21, 2020
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Mitch Weiland
Title
Senior Accountant
Phone
(608) 343-0818

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

N6625 County Road a
Black River Falls, WI 54615-5852

Mailing address

N6625 County Road a
Black River Falls, WI 54615-5852
Phone (715) 284-3100

Other names 1

  • Black River Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1790393270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N6625 COUNTY ROAD A",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546155852",
            "telephone_number": "715-284-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N6625 COUNTY ROAD A",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546155852",
            "telephone_number": "715-284-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER FALLS DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-21",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "WEILAND",
        "authorized_official_first_name": "MITCH",
        "authorized_official_title_or_position": "SENIOR ACCOUNTANT",
        "authorized_official_telephone_number": "608-343-0818"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black River Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Black River Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.