Stephen Ross Prieve, DMD
Individual provider Active NPI Pediatric Dentistry · Verona, WI
NPI 1811490337 · NPPES record last updated Oct 8, 2023
Key facts
- NPI
- 1811490337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 6001081 (WI)
- Practice address
- 220 Keenan Court
Suite #100
Verona, WI 53593 - Phone
- (608) 960-8414
- NPI assigned
- Mar 11, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS-09728 | IA | MD | Pediatric Dentist |
| 6001081 | WI | MD | Pediatric Dentist |
| 16474 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Skies Pediatric Dentistry | Current |
Accepting new patients | |
| Eastern Iowa Periodontics, PC | Past |
Accepting new patients | |
| The Fun Kids Dentist, S.C. | Past |
Accepting new patients | |
| Iowa Pediatric Dental Center | Pediatric Dentistry | Past |
Accepting new patients |
Locations
220 Keenan Ct
Ste 100
Verona, WI 53593
Phone (608) 960-8414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DDS-09728 | IA | |
| Pediatric Dentistry | 1223P0221X | 16474 | MD | |
| Pediatric Dentistry | 1223P0221X | 6001081 | WI | Yes |
Addresses
Primary practice location
220 Keenan Court
Suite #100
Verona, WI 53593
Mailing address
16655 W Bluemound Rd Ste 380
Brookfield, WI 53005-5939
Phone (262) 786-1270
Other practice location 1
16655 W Bluemound Rd Ste 380
Brookfield, WI 53005-5939
Phone (262) 786-1270
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119591300 | Medicaid | MD |
Other providers in Verona, WI
- Alison Polzin
- Aubreonna Poole
- Emily Portillo
- Brittany Rose Post
- Amanda R Preimesberger
- Amanda Purcilly
- Elizabeth Purpero
- Heidi Pyfferoen
- Teagan Pyszka
- Quirt Family Dentistry, S.C.
All providers in Verona, WI · Pediatric Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.