NPIMap

Organization Active NPI

201 Water Front Dental LLC

  • General Practice Dentistry
  • Fort Atkinson, WI
National Provider Identifier
1902912165
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
201 WATER FRONT DENTAL LLC
Practice address
201 Sherman Ave. W.
Fort Atkinson, WI 53538
Phone
(920) 563-7323
Fax
(920) 563-7612
NPI assigned
Aug 21, 2006
Last updated
Nov 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Authorized official

Name
Michael A Bender, DDSNPI 1588770747
Title
1St Vice President
Phone
(920) 563-7323

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 Dentistry 1223G0001X Primary

Addresses

Primary practice location

201 Sherman Ave. W.
Fort Atkinson, WI 53538

Mailing address

201 Sherman Ave. W.
Fort Atkinson, WI 53538
Phone (920) 563-7323

Other identifiers 1

IdentifierTypeStateIssuer
38366000MedicaidWI

National Provider Directory

National Provider Directory

Locations

201 Sherman Ave W
Fort Atkinson, WI 53538
Phone (920) 563-7323

Practitioners & affiliated clinicians

Practitioners 6

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": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1902912165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SHERMAN AVE. W.",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "53538",
            "telephone_number": "920-563-7323",
            "fax_number": "920-563-7612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SHERMAN AVE. W.",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "53538",
            "telephone_number": "920-563-7323",
            "fax_number": "920-563-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "201 WATER FRONT DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "BENDER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "1ST VICE PRESIDENT",
        "authorized_official_telephone_number": "920-563-7323",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38366000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.

Verify at the official NPI Registry.