Kelly Gruetzmacher Groskopf, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1001308-15 Issued in WI

Practice address

W381N8165 Rolling River Cir
Oconomowoc, WI 53066-8950

Phone

(715) 459-3222

NPI assigned

Jun 2, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kelly Marie Gruetzmacher Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Showalter, Inc

  • General Practice Dentistry
  • Fort Atkinson, WI
  • NPI 1508187758
  NPD (past)

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488499200000",
    "number": "1962850701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 COMMERCE PKWY",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383139",
            "telephone_number": "920-563-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W381N8165 ROLLING RIVER CIR",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530668950",
            "telephone_number": "715-459-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSKOPF",
        "first_name": "KELLY",
        "middle_name": "GRUETZMACHER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-02",
        "last_updated": "2017-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001308-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "GRUETZMACHER",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Beth Ann Gramz, RDH
• Brittany Morgan Greig, MMT, CPT, MT
• Mark J Grevlich, DDS
• Tamara Grissman, PA-C
• Susan A Groehler, RN
• John W. Gucciardi, M.D.
• Angela Gunderson
• Alecia Guttilla, CLD
• Melissa Hackbarth, LPC
• Bethany Hafenstein-Riege

• General Practice Dentistry in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; 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.