NPIMap

Organization Active NPI

Racine Dental Group S C

  • Dentist
  • Racine, WI
National Provider Identifier
1801941570
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
RACINE DENTAL GROUP S C
Practice address
1320 S Greenbay Rd
Racine, WI 53406-4406
Phone
(262) 637-9371
NPI assigned
Jan 24, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Janice O'Laughlin
Title
Hipaa Officer
Phone
(262) 637-9371

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X WI Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X WI
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X WI
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X WI
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X WI
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X WI

Addresses

Primary practice location

1320 S Greenbay Rd
Racine, WI 53406-4406

Mailing address

1320 S Greenbay Rd
Racine, WI 53406-4406
Phone (262) 637-9371

Other identifiers 1

IdentifierTypeStateIssuer
38393900MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1801941570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 S GREENBAY RD",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534064406",
            "telephone_number": "262-637-9371",
            "fax_number": "262-619-7727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 S GREENBAY RD",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534064406",
            "telephone_number": "262-637-9371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RACINE DENTAL GROUP S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "O'LAUGHLIN",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "HIPAA OFFICER",
        "authorized_official_telephone_number": "262-637-9371",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38393900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.