NPIMap

Organization Active NPI

Lincoln Ave Dental Group SC

  • General Practice Dentistry
  • Milwaukee, WI
National Provider Identifier
1861595324
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5266015 Issued in WI
Legal business name
LINCOLN AVE DENTAL GROUP SC
Practice address
2700 W Lincoln Ave
Milwaukee, WI 53215
Phone
(414) 645-0217
Fax
(414) 645-1502
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Steven Raymond Kanugh, DDSNPI 1710019997
Title
President Dentist
Phone
(414) 645-0217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 3800015 WI
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5266015 WI Primary

Addresses

Primary practice location

2700 W Lincoln Ave
Milwaukee, WI 53215

Mailing address

2700 W Lincoln Ave
Milwaukee, WI 53215
Phone (414) 645-0217

National Provider Directory

National Provider Directory

Locations

2700 W Lincoln Ave
Milwaukee, WI 53215
Phone (414) 645-0217

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861595324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 W LINCOLN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53215",
            "telephone_number": "414-645-0217",
            "fax_number": "414-645-1502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 W LINCOLN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53215",
            "telephone_number": "414-645-0217",
            "fax_number": "414-645-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN AVE DENTAL GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KANUGH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "414-645-0217",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3800015",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5266015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.