NPIMap

Organization Active NPI

South East Wisconsin Endodontic Associates

  • Endodontics
  • Kenosha, WI
National Provider Identifier
1871616888
Registry record updated Jul 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
1984G Issued in WI
Legal business name
SOUTH EAST WISCONSIN ENDODONTIC ASSOCIATES
Practice address
4707 Washington Rd.
Kenosha, WI 53144
Phone
(262) 658-9140
NPI assigned
Apr 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2008

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

Authorized official

Name
James K. KreutzerNPI 1518080522
Title
Dentist
Phone
(262) 658-9140

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X 1984G WI Primary

Addresses

Primary practice location

4707 Washington Rd.
Kenosha, WI 53144

Mailing address

4707 Washington Rd.
Kenosha, WI 53144
Phone (262) 658-9140

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1871616888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4707 WASHINGTON RD.",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53144",
            "telephone_number": "262-658-9140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 WASHINGTON RD.",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53144",
            "telephone_number": "262-658-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH EAST WISCONSIN ENDODONTIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "KREUTZER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "262-658-9140"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "WI",
            "license": "1984G",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.