NPIMap

Organization Active NPI

Fond Du Lac Family Dentistry, LLC

  • Dental Clinic/Center
  • Fond Du Lac, WI
National Provider Identifier
1982271763
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
FOND DU LAC FAMILY DENTISTRY, LLC
Practice address
145 S Marr St Ste 1
Fond Du Lac, WI 54935-4419
Phone
(920) 922-9000
NPI assigned
Jun 9, 2021
Last updated
Jun 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

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

Authorized official

Name
Dr. Daniel Stevens, DDSNPI 1871980573
Title
Owner/Dentist
Phone
(920) 922-9000

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
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

145 S Marr St Ste 1
Fond Du Lac, WI 54935-4419

Mailing address

145 S Marr St Ste 1
Fond Du Lac, WI 54935-4419
Phone (920) 922-9000

National Provider Directory

National Provider Directory

Locations

145 S Marr St
Ste 1
Fond du Lac, WI 54935
Phone (920) 922-9000

Practitioners & affiliated clinicians

Practitioners 3

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": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1982271763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 S MARR ST STE 1",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354419",
            "telephone_number": "920-922-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S MARR ST STE 1",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354419",
            "telephone_number": "920-922-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "920-922-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.