Tony Lee Pilgrim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

003104 Issued in WI

Practice address

122 S. State St.
Fall Creek, WI 54742-0066

Phone

(715) 877-2113

Fax

(715) 877-3495

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Fall Creek Dental

  • General Practice Dentistry
  • Fall Creek, WI
  • NPI 1295955342
  NPD (past) Authorized official
• Fall Creek Family Dental, LLC

  • General Practice Dentistry
  • Fall Creek, WI
  • NPI 1861256620
  NPD (past)

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861545055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6824 TOWER DR",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547038773",
            "telephone_number": "715-855-1105",
            "fax_number": "715-855-1163"
        },
        {
            "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": "547420066",
            "telephone_number": "715-877-2113",
            "fax_number": "715-877-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PILGRIM",
        "first_name": "TONY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "003104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33458700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lorri Lynn Hellegers, R.D.H.
• Peter Mandelert Ihle, M.D.
• Nicole McEvoy
• Beth McVey, D.C.
• Cynthia Gail Mickelson, DC
• Mary B Price, MS CCC
• Theodore Shawn Regalia, R.PH.
• Christine Rogers
• Kevin Wang
• Breanna Winsand, RN

• 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 Jul 8, 2007; 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.