BARK RIVER DENTAL GROUP (NPI# 1003936279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003936279 |
| Entity Type | Organization |
| Organization Name | BARK RIVER DENTAL GROUP |
| Practice Address |
625 Walnut Ridge Dr Hartland WI 53029-8894 |
| Practice Telephone | 2623674255 |
| Practice Fax Number | 2623674714 |
| Mailing Telephone | 2623674255 |
| Mailing Fax Number | 2623674714 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MICHAEL JON VITENSE (PRESIDENT) |
| Authorized Official Telephone | 2623674255 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
1722G | WI | Dental Providers |
| Street Address |
625 WALNUT RIDGE DR |
| City | HARTLAND |
| State | WI |
| Zip Code | 53029-8894 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063042539 | Marjorie Stuart | Technician | 2410 Hirschman Lane, Hartland, WI 53029 | 2020-01-23 |
| 1063854149 | Madeline M Walter | Dentist | 231 Lawn Street, Modern Touch Dental, Hartland, WI 53029 | 2013-07-18 |
| 1801235403 | Kelly L.m. Newman | Dentist | 139 E. Capitol Dr., Hartland, WI 53029 | 2013-06-18 |
| 1124465323 | Ascension St Francis Hospital, Inc | General Acute Care Hospital | 609 River Meadow Drive, Hartland, WI 53029 | 2013-05-28 |
| 1528313384 | Kristina Johnson | Physical Therapist | 600 Hartbrook Dr Ste 111, Hartland, WI 53029 | 2012-07-18 |
| 1578822565 | Kacie Estes Walters | Chiropractor | 1120 James Dr Ste B, Hartland, WI 53029 | 2012-05-10 |
| 1639485428 | Lisa Renae Herpolsheimer | Social Worker | W331 N9103 West Shore Drive, Hartland, WI 53029 | 2010-08-31 |
| 1063669943 | John Light Atlee Sr. | Anesthesiology | W309 N6698 Caddy Court, John L. Atlee, M.d., Hartland, WI 53029 | 2008-08-22 |
| 1598947053 | Merton Community School District | Local Education Agency (LEA) | W28320 Sussex Road, Hartland, WI 53029 | 2007-11-27 |
| 1407057441 | George Chris Panos | Dentist | N 67 W 31027 Club Circle East, Hartland, WI 53029 | 2007-05-29 |
| Find all providers in zip 53029 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992262125 | Hartland Dental Care, Pllc | Dentist | 11525 Highland Rd Ste 21, Hartland, MI 48353-2726 | 2019-02-24 |
| 1710122809 | Terese Honel Bailey | Dentist | 557 Cottonwood Ave, Hartland, WI 53029-2347 | 2008-12-03 |
| 1831211218 | Thomas Louis Bouhana | Dentist | 11479 Highland Rd, Hartland, MI 48353-2737 | 2007-04-04 |
| 1639290208 | Dennis S Ora | Dentist | 11140 Highland Rd, Hartland, MI 48353-2702 | 2007-04-02 |
| 1477699858 | John R Cabell | Dentist | 11436 Highland Rd, Hartland, MI 48353-2735 | 2007-01-30 |
| 1770636862 | Thomas L Spangler | Dentist | 231 Lawn St, Hartland, WI 53029-1705 | 2007-01-19 |
| 1629140330 | Norbert Alphonse Zonca | Dentist | 12319 Highland Rd, Suite 100, Hartland, MI 48353 | 2006-11-15 |
| 1952487274 | Richard John Huber | Dentist | 24 Great Moose Dr, Hartland, ME 04943-3022 | 2006-10-29 |
| 1376636746 | Grant A Lemke | Dentist | 3079 Village Square Dr, Hartland, WI 53029-8361 | 2006-09-30 |
| 1952334617 | James R Muenzenberger | Dentist | 139 E Capitol Dr, Hartland, WI 53029-2100 | 2006-07-08 |
| Find all providers in HARTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.