NPIMap

Organization Active NPI

Downtown Family Dental of West Bend, Inc

  • General Practice Dentistry
  • West Bend, WI
National Provider Identifier
1881755692
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1412 Issued in WI
Legal business name
DOWNTOWN FAMILY DENTAL OF WEST BEND, INC
Practice address
309 N 7TH Ave
West Bend, WI 53095-3242
Phone
(262) 338-1164
Fax
(262) 338-1646
NPI assigned
Dec 13, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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. Lawrence T. Porter, DDSNPI 1437286390
Title
Owner
Phone
(262) 338-1164

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: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 1412 WI Primary

Addresses

Primary practice location

309 N 7TH Ave
West Bend, WI 53095-3242

Mailing address

309 N 7TH Ave
West Bend, WI 53095-3242
Phone (262) 338-1164

National Provider Directory

National Provider Directory

Locations

309 N 7th Ave
West Bend, WI 53095
Phone (262) 338-1164

Practitioners & affiliated clinicians

Practitioners 4

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881755692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 N 7TH AVE",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953242",
            "telephone_number": "262-338-1164",
            "fax_number": "262-338-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 N 7TH AVE",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953242",
            "telephone_number": "262-338-1164",
            "fax_number": "262-338-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOWNTOWN FAMILY DENTAL OF WEST BEND, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-338-1164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, 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.