Random Lake Dentistry, Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

RANDOM LAKE DENTISTRY, INC

Practice address

37 Hickory Dr
Random Lake, WI 53075-1675

Phone

(920) 994-4367

NPI assigned

Sep 20, 2024

Last updated

Sep 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Hooman Abdolisereshki, D.D.SNPI 1619369279

Title

Owner

Phone

(920) 892-8466

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Hooman Abdolisereshki, DDS

  • Dentist
  • Plymouth, WI
  • NPI 1619369279
  NPD Authorized official
• Gerald Linus Vogler, DDS

  • General Practice Dentistry
  • Random Lake, WI
  • NPI 1801086475
  NPD (past)

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1982421046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 S PLEASANT VIEW RD",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530734954",
            "telephone_number": "920-892-8466",
            "fax_number": "920-892-8467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 HICKORY DR",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751675",
            "telephone_number": "920-994-4367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOM LAKE DENTISTRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "ABDOLISERESHKI",
        "authorized_official_first_name": "HOOMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-892-8466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mueller Therapy, Inc.
• Barbara Junge Mueller, OTR
• Carli V Mueller
• Richard Polk, PT
• Prohealth Chiropractic Center S.C.
• Random Lake Fire Department
• Random Lake Fire Department
• Random Lake Medical Center LLC
• Random Lake Spine & Sports Clinic
• Abby Lynn Risse, PT

• Dental Clinic/Center in Random Lake, WI
• Providers in Random Lake, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.