Jackson Town & Country Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

JACKSON TOWN & COUNTRY DENTAL LLC

Practice address

N168 W20566 Main St
Jackson, WI 53037

Phone

(262) 444-0600

NPI assigned

Sep 7, 2020

Last updated

Sep 7, 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

Mitch Weiland

Title

Senior Accountant

Phone

(608) 343-0818

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1599436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599436800000",
    "number": "1790399780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N168 W20566 MAIN ST",
            "city": "JACKSON",
            "state": "WI",
            "postal_code": "53037",
            "telephone_number": "262-444-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N168 W20566 MAIN ST",
            "city": "JACKSON",
            "state": "WI",
            "postal_code": "53037",
            "telephone_number": "262-444-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON TOWN & COUNTRY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-07",
        "last_updated": "2020-09-07",
        "certification_date": "2020-09-07",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.