Individual provider Active NPI

Dianne Smart

  • General Practice Dentistry
  • Appleton, WI
National Provider Identifier
1821155060
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5062 Issued in WI
Practice address
3030 N Ballard Rd
Appleton, WI 54911-8707
Phone
(920) 954-8085
Fax
(920) 954-9080
NPI assigned
Jan 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5062 WI Primary

Addresses

Primary practice location

3030 N Ballard Rd
Appleton, WI 54911-8707

Mailing address

3030 N Ballard Rd
Appleton, WI 54911-8707
Phone (920) 954-8085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160105001556 WI Order and Referring Only - DentistPractitioner - Dentist 3476855669

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5062WIMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821155060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 N BALLARD RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118707",
            "telephone_number": "920-954-8085",
            "fax_number": "920-954-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 N BALLARD RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118707",
            "telephone_number": "920-954-8085",
            "fax_number": "920-954-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMART",
        "first_name": "DIANNE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.