Active NPI
Kurt A Walejko, D.D.S.
- Dentist
- Oshkosh, WI
National Provider Identifier
1821378803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6731-015
- Practice address
- 1795 W Pointe Dr
Oshkosh, WI 54902-4297 - Phone
- (920) 235-6453
- NPI assigned
- Aug 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6731-015 | WI | Primary |
Addresses
Primary practice location
1795 W Pointe Dr
Oshkosh, WI 54902-4297
Mailing address
1795 W Pointe Dr
Oshkosh, WI 54902-4297
Phone (920) 235-6453
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6731-015 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Dental Center Oshkosh LLC | Dentist | Past | Accepting new patients |
| MDC Oshkosh II, L.L.C. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dentist
- Oshkosh, WI
- NPI 1538815733
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443139200000",
"number": "1821378803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1795 W POINTE DR",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549024297",
"telephone_number": "920-235-6453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1795 W POINTE DR",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549024297",
"telephone_number": "920-235-6453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALEJKO",
"first_name": "KURT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-23",
"last_updated": "2015-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6731-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.