Carol Jean Antisdel, D,D,S,

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2486-015 Issued in WI

Practice address

661 E Green Bay Ave
Saukville, WI 53080-2013

Phone

(262) 284-7111

Fax

(262) 284-1172

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Antisdel Dental Clinic, S.C.

  • General Practice Dentistry
  • Saukville, WI
  • NPI 1649294257
  NPD (past)
• Sauk Trail Dental LLC

  • General Practice Dentistry
  • Saukville, WI
  • NPI 1457697229
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821213653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802013",
            "telephone_number": "262-284-7111",
            "fax_number": "262-284-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802013",
            "telephone_number": "262-284-7111",
            "fax_number": "262-284-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTISDEL",
        "first_name": "CAROL",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D,D,S,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2486-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antisdel Dental Clinic, S.C.
• Robert James Antisdel, D.D.S.
• Balance, Inc.
• Toby Lynn Capaul, RPH
• Children'S Hospital of Wisconsin
• James N Ellis, MSW, LCSW

• General Practice Dentistry in Saukville, WI
• Providers in Saukville, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.