Justin Michael Servais, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

600131415 Issued in WI

Practice address

2830 Darling CT
La Crosse, WI 54601-2754

Phone

(608) 783-7330

NPI assigned

Jul 28, 2023

Sex

Male

Sole proprietor

Yes

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

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1992486203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4702 CREEKWOOD LN APT 304",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537042482",
            "telephone_number": "608-790-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 DARLING CT",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546012754",
            "telephone_number": "608-783-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERVAIS",
        "first_name": "JUSTIN",
        "middle_name": "MICHAEL",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-28",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "600131415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard L Sellman Jr., M.D.
• David L Semple, CRNA
• David F Senkerik, PA
• Stephanie L Serck, PA
• Jayden Serres
• Brian J Sesolak, PA-C
• Amanda Marilynne Seston, PA
• Quinn Lewis Seston, PA
• Andrew M. Severn, D.P.T.
• Brad Severson, PTA

• General Practice Dentistry in La Crosse, WI
• Providers in La Crosse, 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 Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.