Active NPI
Orissa Nitibhon, DMD
- General Practice Dentistry
- Menomonie, WI
National Provider Identifier
1902672066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6001518-15
- Practice address
- 460 Crescent St
Menomonie, WI 54751-1827 - Phone
- (715) 972-9975
- NPI assigned
- Nov 29, 2023
- Sex
- Male
- Sole proprietor
- No
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 | 6001518-15 | WI | Primary |
Addresses
Primary practice location
460 Crescent St
Menomonie, WI 54751-1827
Mailing address
1260 Milton Ave
Janesville, WI 53545-1889
Phone (608) 757-0057
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 |
|---|---|---|---|
| 6001518-15 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737590400000",
"number": "1902672066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1260 MILTON AVE",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535451889",
"telephone_number": "608-757-0057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 CRESCENT ST",
"city": "MENOMONIE",
"state": "WI",
"postal_code": "547511827",
"telephone_number": "715-972-9975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NITIBHON",
"first_name": "ORISSA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-29",
"last_updated": "2025-01-23",
"certification_date": "2025-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "6001518-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menomonie, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.