DOUGLAS D PODOLL DDS SC (NPI# 1063563674) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063563674 |
| Entity Type | Organization |
| Organization Name | DOUGLAS D PODOLL DDS SC |
| Practice Address |
1460 10th Ave Baldwin WI 54002 |
| Mailing Address |
1460 10th Ave Po Box 516 Baldwin WI 54002 |
| Practice Telephone | 7156845858 |
| Practice Fax Number | 7156845968 |
| Mailing Telephone | 7156845858 |
| Mailing Fax Number | 7156845968 |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DOUGLAS D PODOLL (PRESIDENT) |
| Authorized Official Telephone | 7156845858 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
3237 | WI | Dental Providers |
| Street Address |
1460 10TH AVE |
| City | BALDWIN |
| State | WI |
| Zip Code | 54002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194894907 | David E Scott | Dentist | 1460 10th Ave, Suite B, Baldwin, WI 54002-9342 | 2006-11-07 |
| 1104205285 | Kristo Ltd | Dentist | 1460 10th Ave, Baldwin, WI 54002-9342 | 2015-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477099026 | Nichole Mattison | Radiologic Technologist | 1180 Oak St, Baldwin, WI 54002 | 2017-01-06 |
| 1497807929 | Dane L Rasmussen | Pharmacist | 840 Main St., Baldwin, WI 54002 | 2007-01-17 |
| 1114083912 | Douglas Earl Jacot | Chiropractor | 1640 Tenth Avenue, Baldwin, WI 54002 | 2006-12-28 |
| 1902907454 | Michael Lee Douglas | Family Medicine | 1110 Bergslien Street, Baldwin, WI 54002 | 2006-09-26 |
| 1427092196 | Shaima Sulemankhil | Family Medicine | 730 10th Ave., Baldwin, WI 54002 | 2006-06-15 |
| 1538114079 | Village of Baldwin | Ambulance | 630 Highway 12, Baldwin, WI 54002 | 2006-05-23 |
| 1861001083 | Marina Cheung Taylor | Physical Therapist | 990 Main Street, Suite #1, Baldwin, WI 54002 | 2020-07-23 |
| 1497245625 | Meghan Ann Becker | Physical Therapist | 650 Birch St, Baldwin, WI 54002 | 2018-05-14 |
| 1720599673 | Karli Rae Kerrschneider | Nurse Practitioner | 1100 Bergslien St, Baldwin, WI 54002 | 2017-10-18 |
| 1730446477 | Brittany Beeson | Family Medicine | 1100 Bergslien St, Baldwin, WI 54002 | 2012-04-19 |
| Find all providers in zip 54002 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104205285 | Kristo Ltd | Dentist | 1460 10th Ave, Baldwin, WI 54002-9342 | 2015-05-22 |
| 1619008463 | South Shore Orthodontics, LLC | Dentist | 2280 Grand Ave, Suite 305, Baldwin, NY 11510-3164 | 2007-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407488075 | Kristo Ltd | Dentist | 440 Chestnut St # 100, Wisconsin Rapids, WI 54494-4807 | 2020-02-11 |
| 1578104006 | Daniela Amaya Fuenmayor | Dentist | 11011 W North Ave Apt 367, Wauwatosa, WI 53226-2271 | 2019-10-07 |
| 1295382992 | Noble Orthodontics, LLC | Dentist | 109 N Dodge St, Burlington, WI 53105-1918 | 2019-08-19 |
| 1295391472 | Christine Lowdon Triggs | Dentist | 21680 West Bluemound Rd, Waukesha, WI 53186 | 2019-05-14 |
| 1811498561 | Orthodontic Specialists of Onalaska and The Coulee Region | Dentist | 2747 National Dr, Onalaska, WI 54650-8784 | 2018-02-27 |
| 1508247198 | Lauren Evan Montoure Teske | Dentist | 2000 Shady Ln, Green Bay, WI 54313-9311 | 2015-06-09 |
| 1588042154 | Bubon & Associates, Orthodontics, Sc | Dentist | 4950 S 27th St, Milwaukee, WI 53221-2606 | 2015-05-14 |
| 1235517897 | 1bubon & Associates, Orthodontics, Sc | Dentist | 1701 N Mayfair Rd, Suite C, Wauwatosa, WI 53226-3046 | 2015-05-14 |
| 1851779417 | Bubon & Associates, Orthodontics, Sc | Dentist | W188s7830 Racine Ave, Suite 300, Muskego, WI 53150-8290 | 2015-05-14 |
| 1578941548 | Bubon & Associates, Orthodontics, Sc | Dentist | N4w21680 Bluemound Rd, Waukesha, WI 53186-2943 | 2015-05-11 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DOUGLAS D PODOLL DDS SC.
| 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.