Oshkosh Family Dental 2, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

OSHKOSH FAMILY DENTAL 2, LLC

Practice address

1825 W Pointe Dr
Oshkosh, WI 54902-4174

Phone

(608) 833-2213

NPI assigned

Apr 15, 2019

Organization subpart

No

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

Authorized official

Name

Olga Grenova

Title

Controller

Phone

(608) 215-5899

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556236800000",
    "number": "1831752096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8025 EXCELSIOR DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171900",
            "telephone_number": "608-215-5899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 W POINTE DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549024174",
            "telephone_number": "608-833-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSHKOSH FAMILY DENTAL 2, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-15",
        "last_updated": "2019-04-26",
        "status": "A",
        "authorized_official_last_name": "GRENOVA",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "608-215-5899"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Oshkosh, WI
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2019; 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.