Active NPI
John Nicholas Demetropoulos, DDS
- General Practice Dentistry
- Tomah, WI
National Provider Identifier
1891898748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3177-015
- Practice address
- Tomah VA Medical Center
500 E. Veterans Street
Tomah, WI 54660 - Phone
- (608) 372-3971
- Fax
- (608) 372-1655
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3177-015 | WI | Primary |
Addresses
Primary practice location
Tomah VA Medical Center
500 E. Veterans Street
Tomah, WI 54660
Mailing address
E12875 Wynding Way
Merrimac, WI 53561-9599
Phone (262) 312-4752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3177-015 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706227200000",
"number": "1891898748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "E12875 WYNDING WAY",
"city": "MERRIMAC",
"state": "WI",
"postal_code": "535619599",
"telephone_number": "262-312-4752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "TOMAH VA MEDICAL CENTER",
"address_2": "500 E. VETERANS STREET",
"city": "TOMAH",
"state": "WI",
"postal_code": "54660",
"telephone_number": "608-372-3971",
"fax_number": "608-372-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMETROPOULOS",
"first_name": "JOHN",
"middle_name": "NICHOLAS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2024-01-26",
"certification_date": "2024-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "3177-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tomah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.