Waterford Childrens Dentistry SC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

WATERFORD CHILDRENS DENTISTRY SC

Practice address

790 Cornerstone Xing
Waterford, WI 53185-4582

Phone

(414) 350-0945

NPI assigned

Jul 31, 2023

Organization subpart

Yes

Parent organization

PARAMOUNT PEDIATRIC DENTISTRY SCAs reported in NPPES

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

Authorized official

Name

Christy Frady, DMDNPI 1801080106

Title

Owner

Phone

(414) 350-0945

Specialties & licenses 1

Addresses

Other names 2

• Paramount Pediatric Dentistry Other name
• Waterford Childrens Dentistry SC Former legal business name

Part of

Paramount Pediatric Dentistry SC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Paramount Pediatric Dentistry SC

  • Pediatric Dentistry
  • Hales Corners, WI
  • NPI 1831545763
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christy L Frady, D.M.D.

  • Pediatric Dentistry
  • Hales Corners, WI
  • NPI 1801080106
  NPD Authorized official

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

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1982385944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 CORNERSTONE XING",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531854582",
            "telephone_number": "414-350-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CORNERSTONE XING",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531854582",
            "telephone_number": "414-350-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD CHILDRENS DENTISTRY SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARAMOUNT PEDIATRIC DENTISTRY SC",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "FRADY",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-350-0945",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paramount Pediatric Dentistry",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Waterford Childrens Dentistry SC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Paramount Pediatric Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pediatric Dentistry in Waterford, WI
• Providers in Waterford, WI by specialty
• Pediatric Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.