Courtney Miyamoto, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1001957 Issued in WI

Practice address

545 E Johnson St
Fond Du Lac, WI 54935-2856

Phone

(920) 924-9090

NPI assigned

Jul 12, 2018

Sex

Female

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 WI

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

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.

• Dental Associates LTD of Wisconsin

  • Endodontics
  • Wauwatosa, WI
  • NPI 1518266998

  General Practice

  NPD (past)
• Dental Assosiates

  • Dental Clinic/Center
  • Fond Du Lac, WI
  • NPI 1558710269
  NPD (past)
• Miyamoto Dental Design Suite, Inc.

  • General Practice Dentistry
  • Wailuku, HI
  • NPI 1831218916
  NPD (past)

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1891271987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 E JOHNSON ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549352856",
            "telephone_number": "920-924-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 E JOHNSON ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549352856",
            "telephone_number": "920-924-9090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1885 Main St Ste 203",
            "address_purpose": "LOCATION",
            "city": "Wailuku",
            "state": "HI",
            "postal_code": "967931827",
            "country_code": "US",
            "telephone_number": "808-242-7007",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2100 Miller Park Way",
            "address_purpose": "LOCATION",
            "city": "West Milwaukee",
            "state": "WI",
            "postal_code": "532191641",
            "country_code": "US",
            "telephone_number": "414-645-4540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIYAMOTO",
        "first_name": "COURTNEY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-12",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "DT2760",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allieson Elizabeth Mirsberger, LMT
• Bryan Mischler, LCSW
• Makenna Mitchell
• Kathy Mitchem
• Leonora Mitre
• Tiffany Lynn Mlodzik, APNP
• Modern Dental Center LLC
• David G Moehn, MS, CCC-SLP
• Jordan Moehn, MS, LAT, ATC
• Amanda Moehring, RN

• General Practice Dentistry in Fond Du Lac, WI
• Providers in Fond Du Lac, 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 Oct 30, 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.