Active NPI
Eliot Vildaver, DMD
- Dentist
- Mount Pleasant, WI
National Provider Identifier
1841643285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1001396
- Practice address
- 5201 Washington Ave
Suite a
Mount Pleasant, WI 53406-4242 - Phone
- (888) 988-4066
- Fax
- (847) 496-4850
- NPI assigned
- Jul 21, 2016
- Last updated
- Oct 12, 2016
- 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 | 1001396 | WI | Primary |
Addresses
Primary practice location
5201 Washington Ave
Suite a
Mount Pleasant, WI 53406-4242
Mailing address
2050 E Algonquin Rd Ste 610
Schaumburg, IL 60173-4166
Phone (888) 988-4066
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160805002444 | WI | Order and Referring Only - Dentist | 7719271246 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001396 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Familia Dental Racine LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476230400000",
"number": "1841643285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 E ALGONQUIN RD STE 610",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601734166",
"telephone_number": "888-988-4066",
"fax_number": "847-496-4850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5201 WASHINGTON AVE",
"address_2": "SUITE A",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534064242",
"telephone_number": "888-988-4066",
"fax_number": "847-496-4850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILDAVER",
"first_name": "ELIOT",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-21",
"last_updated": "2016-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "1001396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, WI
- Wynne Venard, PT
- Alexis Marie Ventura, DNP, CRNA
- Tia Vernon, M.D.
- Sheldon Vielie, RPH
- Viet Vignieri, PA-C
- Village of Mount Pleasant (South Shore Consolidated Fire Department)
- Macey Lynn Villarreal, LCSW
- Vita Hearing Care, LLC (Vita Hearing Care)
- Kelly G. Von-Schilling Worth, DC, FIACN, DACAN
- Maria-Gretchen Fabroa Wagner-Richardson, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.