WISCONSIN DENTAL GROUP, S.C. (NPI# 1366572927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366572927 |
| Entity Type | Organization |
| Organization Name | WISCONSIN DENTAL GROUP, S.C. |
| Other Organization Name | FORWARD DENTAL |
| Practice Address |
6218 Washington Ave Ste C Racine WI 53406-3916 |
| Practice Telephone | 2628861300 |
| Practice Fax Number | 2628861837 |
| Mailing Telephone | 2628861300 |
| Mailing Fax Number | 2628861837 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | PETER YOUNG (VP) |
| Authorized Official Telephone | 4143572040 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 1223E0200X |
Dentist Specialization: Endodontics |
Dental Providers | ||
| X | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Forward Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881726412 | Wisconsin Dental Group, S.c. | Dentist | 5100 W Forest Home Ave, Milwaukee, WI 53219-4527 | 2007-03-09 |
| 1952431090 | Wisconsin Dental Group, S.c. | Dentist | 15100 W. Library Lane, New Berlin, WI 53151 | 2007-03-07 |
| 1194855742 | Wisconsin Dental Group, S.c. | Dentist | 1025 S Moorland Rd Ste 201, Brookfield, WI 53005-6945 | 2007-03-06 |
| 1417087479 | Wisconsin Dental Group, S.c. | Dentist | 705 S 24th Ave, The Galleria, Suite 430, Wausau, WI 54401-5242 | 2007-03-07 |
| 1548390404 | Wisconsin Dental Group, S.c. | Dentist | 10058 W Loomis Rd, Franklin, WI 53132-8109 | 2007-03-07 |
| 1023148681 | Wisconsin Dental Group, S.c. | Dentist | 1407 N Wright Rd, Janesville, WI 53546-1314 | 2007-03-06 |
| 1144350703 | Wisconsin Dental Group, S.c. | Dentist | 3410 80th St, Kenosha, WI 53142-4975 | 2007-03-06 |
| 1437289006 | Wisconsin Dental Group, S.c. | Dentist | 3715 Washington Rd, Kenosha, WI 53144-1629 | 2007-03-06 |
| 1578693149 | Wisconsin Dental Group, S.c. | Dentist | N80w17707 Custer Ln, Menomonee Falls, WI 53051-3630 | 2007-03-06 |
| 1467582916 | Wisconsin Dental Group, S.c. | Dentist | 9134 W Silver Spring Dr, Milwaukee, WI 53225-3414 | 2007-03-06 |
| Street Address |
6218 WASHINGTON AVE STE C |
| City | RACINE |
| State | WI |
| Zip Code | 53406-3916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164349 | Lynn Huynh | Pharmacist | 5695 Washington Ave, Racine, WI 53406 | 2020-11-06 |
| 1659920049 | Carol Jean Cornejo | Technician | 6528 Heritage Avenue, Mt Pleasant, WI 53406 | 2019-09-09 |
| 1265913958 | Mary Goldbeck | Social Worker | 1775 Newman Rd, Mt Pleasant, WI 53406 | 2018-08-22 |
| 1669963344 | Kelly Nicole Nelson | Registered Nurse | 8800 Washington Ave Ste 200, Mount Pleasant, WI 53406 | 2018-05-29 |
| 1891212163 | Ilona Agata Pryomski | Nurse Practitioner | 9201 Washington Ave, Racine, WI 53406 | 2017-08-27 |
| 1386185106 | Margaret M. Abaogye Dds | Dentist | 4340 Newman Rd., Racine, WI 53406 | 2017-03-13 |
| 1508309212 | Rebecca Koeppen | Dietitian, Registered | 8400 Washington Ave., Racine, WI 53406 | 2016-11-29 |
| 1386194371 | Forefront Dermatology, S.c. | Dermatology | 7200 Washington Ave, Suite 100, Mount Pleasant, WI 53406 | 2016-10-13 |
| 1356891402 | Forefront Dermatology, S.c. | Dermatology | 1515 S Green Bay Rd, Racine, WI 53406 | 2016-10-12 |
| 1861841470 | Leah Marie Johnson | Dentist | 1101 South Airline Road, Racine, WI 53406 | 2016-06-06 |
| Find all providers in zip 53406 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275873374 | F Kris Olsen | Dentist | 1320 S Green Bay Road, Racine Dental Group, Racine, WI 53406 | 2013-02-26 |
| 1366546996 | Gregory T Isermann Dds Ms Sc | Dentist | 3500 Meachem Road, Racine, WI 53405-4662 | 2006-09-12 |
| 1023165560 | Shoba Warren | Dentist | 6218 Washington Ave, Suite C, Racine, WI 53406-3916 | 2007-01-05 |
| 1821150418 | Gregory T Isermann | Dentist | 3500 Meachem Rd, Racine, WI 53405-4662 | 2006-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164031464 | Central Wisconsin Endodontic Specialists LLC | Dentist | 2606 Stewart Avenue, #102, Wausau, WI 54401 | 2020-07-23 |
| 1891319273 | Janesville Endodontics | Dentist | 1616 N Randall Ave Ste 180, Janesville, WI 53545-1155 | 2020-06-02 |
| 1306480918 | Teng Kai Ong | Dentist | 1801 West Wisconsin Ave., Milwaukee, WI 53233 | 2019-11-06 |
| 1215344478 | Helen Tsao | Dentist | 2606 Stewart Ave, Ste 102, Wausau, WI 54401-5502 | 2014-07-18 |
| 1275973166 | Meridian Endodontics and Periodontics | Dentist | 20350 Water Tower Blvd Ste 203, Brookfield, WI 53045-3558 | 2013-06-25 |
| 1447698451 | Eva C Dahl | Dentist | 2700 National Dr Ste 1, Onalaska, WI 54650-6708 | 2013-06-12 |
| 1063710655 | Erik Daniel Deyoung | Dentist | 6100 W State St, Apt. 636, Wauwatosa, WI 53213-2983 | 2011-03-05 |
| 1376786285 | Ronald David Meyers | Dentist | 2600 N Mayfair Rd Ste 240, Wauwatosa, WI 53226-1309 | 2009-04-08 |
| 1942450457 | Wisconsin Endodontic Group, S.c. | Dentist | 2600 N. Mayfair Rd., Ste 240, Wauwatosa, WI 53226 | 2008-09-22 |
| 1558519058 | Kendra Kay Boda | Dentist | 3004 Golf Rd Ste 102, Eau Claire, WI 54701-8794 | 2008-09-09 |
| Find all providers with the same taxonomy | ||||
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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.