KENOSHA DENTIST LLC (NPI# 1205364197) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205364197 |
| Entity Type | Organization |
| Organization Name | KENOSHA DENTIST LLC |
| Practice Address |
5455 Sheridan Rd Ste 201 Kenosha WI 53140-3752 |
| Practice Telephone | 2622440700 |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-23 |
| Authorized Official Name | DOMINIC KACZYNSKI (BUSINESS MANAGER) |
| Authorized Official Telephone | 2622440700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 1699101477 | 05 |
| Street Address |
5455 SHERIDAN RD STE 201 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53140-3752 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225663396 | Lydia Zopf | Counselor | 2001 Alford Park Dr., Carthage College, Kenosha, WI 53140 | 2020-03-09 |
| 1952949406 | Rotate Rehabilitation and Performance | Physical Therapist | 5606 6th Avenue Suite Ll9, Kenosha, WI 53140 | 2019-12-16 |
| 1134778590 | Brenda Chiapetta | Registered Nurse | 3233 23rd Ave, Kenosha, WI 53140 | 2019-09-09 |
| 1275003394 | Kimberly Shaffner | Family Medicine | 4536 22nd Avenue, Kenosha, WI 53140 | 2018-12-01 |
| 1659863389 | Bart L Mengo | Contractor | 1715 60th Street, Kenosha, WI 53140 | 2018-05-30 |
| 1093182941 | Guided Wellness Counseling | Community/Behavioral Health | 1112 56th St, Kenosha, WI 53140 | 2015-08-26 |
| 1376970764 | Stacey L Andersen | Acupuncturist | 5603 7th Ave, Kenosha, WI 53140 | 2013-10-01 |
| 1841467438 | Deborah Schwerdtfeger | Occupational Therapy Assistant | 3415 Sheridan Road, Woodstock Rehab Dept, Kenosha, WI 53140 | 2008-05-13 |
| 1942492020 | Rebecca Ann Burdette | Counselor | 920 60th Street, Renosha, WI 53140 | 2007-08-13 |
| 1851598619 | Aurora Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 2707 15th Place, Kenosha, WI 53140 | 2007-06-27 |
| Find all providers in zip 53140 | ||||
| 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 |
|---|---|---|---|---|
| 1154782209 | Familia Dental Kenosha LLC | Dentist | 6430 Green Bay Rd, Ste 112, Kenosha, WI 53142-2948 | 2016-03-17 |
| 1831365907 | Martha C. Villasenor | Dentist | 7177 W. Green Bay Rd., 7177 W. Green Bay Rd., Kenosha, WI 53142-1450 | 2008-05-07 |
| 1649464090 | Vincent C Rizzo | Dentist | 7536 39th Avenue, Kenosha, WI 53142 | 2007-08-29 |
| 1972793099 | Robert C. Salituro | Dentist | 3515 75th St, Kenosha, WI 53142-7224 | 2007-07-25 |
| 1821292806 | Robert Stephen Willding | Dentist | 7003 39th Avenue, Kenosha, WI 53142-7132 | 2007-06-13 |
| 1578782520 | Todd Armstrong | Dentist | 7910 39th Ave, Kenosha, WI 53142-2132 | 2007-04-25 |
| 1316063530 | Michael Anthony Walsh | Dentist | 2600 22nd Ave, Kenosha, WI 53140-4813 | 2007-03-21 |
| 1497889216 | Luigi A Caira | Dentist | 4320 60th St, Kenosha, WI 53144-2577 | 2007-03-15 |
| 1740314293 | Charles Marquiss Ashley | Dentist | 7505 38th Ave, Kenosha, WI 53142-4341 | 2007-03-15 |
| 1780721654 | Dr. Rand Lee, Sc | Dentist | 3103 75th St, Kenosha, WI 53142-4443 | 2007-01-31 |
| Find all providers in KENOSHA | ||||
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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.