NPIMap

Organization Active NPI

La Crosse Pediatric Dentistry LLC

  • Clinic/Center
  • La Crosse, WI
National Provider Identifier
1831550813
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
1001174-15 Issued in WI
Legal business name
LA CROSSE PEDIATRIC DENTISTRY LLC
Practice address
2 Copeland Ave Ste 203
La Crosse, WI 54603-3419
Phone
(608) 782-4054
Fax
(608) 782-2198
NPI assigned
Mar 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Authorized official

Name
Dr. Jonathan M Hanks, DDS
Title
Onwer/DDS
Phone
(608) 782-4054

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1001174-15 WI Primary

Addresses

Primary practice location

2 Copeland Ave Ste 203
La Crosse, WI 54603-3419

Mailing address

2 Copeland Ave Ste 203
La Crosse, WI 54603-3419
Phone (608) 782-4054

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1831550813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 COPELAND AVE STE 203",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546033419",
            "telephone_number": "608-782-4054",
            "fax_number": "608-782-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 COPELAND AVE STE 203",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546033419",
            "telephone_number": "608-782-4054",
            "fax_number": "608-782-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CROSSE PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "HANKS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ONWER/DDS",
        "authorized_official_telephone_number": "608-782-4054",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "1001174-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.