Fall Creek Family Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FALL CREEK FAMILY DENTAL, LLC

Practice address

122 S State St
Fall Creek, WI 54742-9701

Phone

(715) 877-2113

NPI assigned

Feb 12, 2024

Organization subpart

No

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

Authorized official

Name

Genie Kuble

Title

Npi Authorized Official

Phone

(920) 450-0157

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tony Lee Pilgrim, DDS

  • General Practice Dentistry
  • Fall Creek, WI
  • NPI 1861545055
  NPD (past)

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1861256620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 S STATE ST",
            "city": "FALL CREEK",
            "state": "WI",
            "postal_code": "547429701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S STATE ST",
            "city": "FALL CREEK",
            "state": "WI",
            "postal_code": "547429701",
            "telephone_number": "715-877-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALL CREEK FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "KUBLE",
        "authorized_official_first_name": "GENIE",
        "authorized_official_title_or_position": "NPI AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "920-450-0157"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Covenant Care LLC (Fall Creek Valley Care Center)
• Virginia Carol Duerst, PHD
• Enigma Psychological Inc.
• Fall Creek Chiropractic Inc.
• Fall Creek Dental
• Fall Creek Pharmacy, Inc. (Fall Creek Pharmacy)
• Fall Creek School District
• Lorri Lynn Hellegers, R.D.H.
• Peter Mandelert Ihle, M.D.
• Nicole McEvoy

• General Practice Dentistry in Fall Creek, WI
• Providers in Fall Creek, 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 Feb 12, 2024; 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.