Eric D Iwen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6425-015 Issued in WI

Practice address

3600 Tower Ave
Superior, WI 54880-5589

Phone

(715) 394-5411

Fax

(715) 392-5086

NPI assigned

Jul 15, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lake Superior Dental Associates

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1871672584
  Medicare reassignment NPD
• Sla Dental PLLC

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1669894705
  NPD (past)

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

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1871723593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N 34TH ST STE 200",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804477",
            "telephone_number": "715-395-5380",
            "fax_number": "715-394-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 TOWER AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805589",
            "telephone_number": "715-394-5411",
            "fax_number": "715-392-5086"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4325 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558072730",
            "country_code": "US",
            "telephone_number": "218-628-7035",
            "fax_number": "218-624-6594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IWEN",
        "first_name": "ERIC",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-15",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "GD42",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6425-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Lee Hurin, RN
• Maureen Nicole Hyde, D.C.
• Blaire Marie Hysjulien, LCSW
• Integrated Wound Care Management Wisconsin LLC
• Julie M Isaksen, LICSW
• James a. Reedstrom, O.D., LTD.
• Daniel Scott James
• Janovick Family Chiropractic SC
• Charles Melvin Janovick, D.C.
• Trinity Janowski

• General Practice Dentistry in Superior, WI
• Providers in Superior, 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 Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.