NPIMap

Organization Active NPI

Quirt Family Dentistry, SC

Doing business as Four Lakes Family Dental

  • General Practice Dentistry
  • Madison, WI
National Provider Identifier
1811356926
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
QUIRT FAMILY DENTISTRY, SC
Doing business as
Four Lakes Family Dental
Practice address
6038 Gemini Drive
Madison, WI 53718
Phone
(608) 807-1524
NPI assigned
Feb 17, 2016
Last updated
Mar 11, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
QUIRT FAMILY DENTISTRY, SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Authorized official

Name
Kendra Walker
Title
Credentialing Team Lead
Phone
(217) 540-8312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

6038 Gemini Drive
Madison, WI 53718

Mailing address

6038 Gemini Drive
Madison, WI 53718

Other names 1

  • Four Lakes Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family Dental of South Sheboygan32 organizations share this tax ID, including this one
Part of
Family Dental of South Sheboygan

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

6038 Gemini Dr
Madison, WI 53718
Phone (608) 807-1524

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1811356926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6038 GEMINI DRIVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6038 GEMINI DRIVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53718",
            "telephone_number": "608-807-1524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUIRT FAMILY DENTISTRY, SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUIRT FAMILY DENTISTRY, SC",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Lakes Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; 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.