NPIMap

Organization Active NPI

Abc Family Dental Services, S.C.

  • General Practice Dentistry
  • Luxemburg, WI
National Provider Identifier
1871638254
Registry record updated Apr 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4930 AND 4892 Issued in WI
Legal business name
ABC FAMILY DENTAL SERVICES, S.C.
Practice address
613 Center Dr
Luxemburg, WI 54217-1031
Phone
(920) 845-2225
Fax
(920) 845-5627
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2009

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

Authorized official

Name
Dr. Bryan William Iwen, D.D.S.NPI 1861537300
Title
President
Phone
(920) 845-2225

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
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 4930 AND 4892 WI Primary

Addresses

Primary practice location

613 Center Dr
Luxemburg, WI 54217-1031

Mailing address

613 Center Dr
Luxemburg, WI 54217-1031
Phone (920) 845-2225

Other identifiers 2

IdentifierTypeStateIssuer
33740400MedicaidWI
33744300MedicaidWI

National Provider Directory

National Provider Directory

Locations

613 Center Dr
Luxemburg, WI 54217
Phone (920) 845-2225

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239753600000",
    "number": "1871638254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 CENTER DR",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171031",
            "telephone_number": "920-845-2225",
            "fax_number": "920-845-5627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 CENTER DR",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171031",
            "telephone_number": "920-845-2225",
            "fax_number": "920-845-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC FAMILY DENTAL SERVICES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2009-04-15",
        "status": "A",
        "authorized_official_last_name": "IWEN",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-845-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4930 AND 4892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33740400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33744300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Luxemburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2009; 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.