NPIMap

Organization Active NPI

Aesthetic and Reconstructive Dentistry, LLC

  • Prosthodontics
  • Madison, AL
National Provider Identifier
1902297690
Registry record updated Feb 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
5928 Issued in AL
Legal business name
AESTHETIC AND RECONSTRUCTIVE DENTISTRY, LLC
Practice address
1041 Balch Rd
Suite 180
Madison, AL 35758-8343
Phone
(256) 319-3256
Fax
(256) 319-3257
NPI assigned
Feb 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2015

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

Authorized official

Name
Dr. Cramin Peter Wiltz II, DMD, CDTNPI 1962835553
Title
Sole Member
Phone
(256) 319-3256

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ProsthodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0700X 5928 AL Primary
Dental Laboratory 292200000X 233720-00 AL

Addresses

Primary practice location

1041 Balch Rd
Suite 180
Madison, AL 35758-8343

Mailing address

1041 Balch Rd
Suite 180
Madison, AL 35758-8343
Phone (256) 319-3256

Other names 1

  • Madison Prosthodontics: Aesthetic and Reconstructive Dentistry, LLC Doing business as

National Provider Directory

National Provider Directory

Locations

1041 Balch Rd
Ste 180
Madison, AL 35758
Phone (256) 319-3256

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424131200000",
    "number": "1902297690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 BALCH RD",
            "address_2": "SUITE 180",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357588343",
            "telephone_number": "256-319-3256",
            "fax_number": "256-319-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 BALCH RD",
            "address_2": "SUITE 180",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357588343",
            "telephone_number": "256-319-3256",
            "fax_number": "256-319-3257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC AND RECONSTRUCTIVE DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-17",
        "last_updated": "2015-02-17",
        "status": "A",
        "authorized_official_last_name": "WILTZ",
        "authorized_official_first_name": "CRAMIN",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "256-319-3256",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DMD, CDT"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "AL",
            "license": "5928",
            "primary": true
        },
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "AL",
            "license": "233720-00",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Prosthodontics: Aesthetic and Reconstructive Dentistry, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; 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.