Emily Rose Nesic, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

100237915 Issued in WI

Practice address

580 Broad St
Lake Geneva, WI 53147-1420

Phone

(262) 248-2773

NPI assigned

Jul 22, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Nesic Dentl Lounge

  • Dental Clinic/Center
  • Menomonee Falls, WI
  • NPI 1164234290
  NPD Authorized official
• Lake Geneva Dental Care LLC

  • General Practice Dentistry
  • Lake Geneva, WI
  • NPI 1083732101
  NPD (past)

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1962010249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 SOUTHWIND DR UNIT 207",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531474713",
            "telephone_number": "815-830-5729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 BROAD ST",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531471420",
            "telephone_number": "262-248-2773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NESIC",
        "first_name": "EMILY",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-22",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "100237915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gary Myron, M.D.
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• Michelle R Nelson, PA
• Lora A Nerland, DO
• Marshall R Nettesheim, PT
• Brandon Newsome
• Kato James Nichols, PHARMD
• Shallin Rose Niemyjski, PTA
• Yemalin Lambert Noudegbessi, PHARMD

• Dentist in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.