Theresa Gardocki, DENTIS

Primary specialty

DentistTaxonomy code 122300000X

License

3054 Issued in WI

Practice address

600 Pleasant Oak Dr
Oregon, WI 53575-3648

Phone

(608) 835-3388

Fax

(608) 835-3386

NPI assigned

Sep 27, 2006

Last updated

Jan 26, 2009By 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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Oregon Dental Professionals LLC

  • Dentist
  • Oregon, WI
  • NPI 1700539723
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232928000000",
    "number": "1801987631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PLEASANT OAK DR",
            "city": "OREGON",
            "state": "WI",
            "postal_code": "535753648",
            "telephone_number": "608-835-3388",
            "fax_number": "608-835-3386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PLEASANT OAK DR",
            "city": "OREGON",
            "state": "WI",
            "postal_code": "535753648",
            "telephone_number": "608-835-3388",
            "fax_number": "608-835-3386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDOCKI",
        "first_name": "THERESA",
        "credential": "DENTIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2009-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "3054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33458500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beatriz M Folcik, PA-C
• Lisa Fowlkes, ATHLETIC TRAINER
• Franhold LLC (Acti-Kare Responsive In-Home Care)
• Carrie Ann Fry, OTR
• Sherry Gahagan
• Sonya Socorro Garza
• David Alfred Gebhardt, SAC
• Cheryl Jo Ginther, P.T.
• Kelly L Goodrich, RN
• Joshua D Graber, DDS

• Dentist in Oregon, WI
• Providers in Oregon, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.