NPIMap

Organization Active NPI

Idental LLC

  • Dentist
  • Mt Pleasant, WI
National Provider Identifier
1861867947
Registry record updated Dec 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
IDENTAL LLC
Practice address
1320 S Green Bay Rd
Mt Pleasant, WI 53406-4406
Phone
(847) 561-1424
NPI assigned
Dec 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2015

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

Authorized official

Name
Vivek Vasudeva
Title
Co-Ceo
Phone
(847) 561-1424

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1320 S Green Bay Rd
Mt Pleasant, WI 53406-4406

Mailing address

1320 S Green Bay Rd
Mt Pleasant, WI 53406-4406

National Provider Directory

National Provider Directory
Tax ID family
Idental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1861867947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 S GREEN BAY RD",
            "city": "MT PLEASANT",
            "state": "WI",
            "postal_code": "534064406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 S GREEN BAY RD",
            "city": "MT PLEASANT",
            "state": "WI",
            "postal_code": "534064406",
            "telephone_number": "847-561-1424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-01",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "VASUDEVA",
        "authorized_official_first_name": "VIVEK",
        "authorized_official_title_or_position": "CO-CEO",
        "authorized_official_telephone_number": "847-561-1424"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.