SUMMIT SQUARE DENTAL LLC (NPI# 1144764978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144764978 |
| Entity Type | Organization |
| Organization Name | SUMMIT SQUARE DENTAL LLC |
| Other Organization Name | SUMMIT SQUARE DENTISTRY |
| Practice Address |
3228 Turnberry Oak Dr Waukesha WI 53188-3969 |
| Practice Telephone | 2625440171 |
| Mailing Telephone | 2625440171 |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2016-12-13 |
| Authorized Official Name | TIMOTHY J MATHISON (PRESIDENT & CEO) |
| Authorized Official Telephone | 6087098303 |
| Is Organization Subpart | Y |
| Parent Organization Name | STEPPING STONE DENTAL PARTNERS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Summit Square Dentistry | Former Legal Business Name - Organization |
| Street Address |
3228 TURNBERRY OAK DR |
| City | WAUKESHA |
| State | WI |
| Zip Code | 53188-3969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316948516 | Mark A Dagenais | Optometrist | 3228 Turnberry Oak Dr, Ste 200, Waukesha, WI 53188-3971 | 2005-08-10 |
| 1659332823 | The Eye Group Sc | Optometrist | 3228 Turnberry Oak Dr, Suite 200, Waukesha, WI 53188-3969 | 2006-03-29 |
| 1548262033 | Marcus J Neitzke | Optometrist | 3228 Turnberry Oak Dr, Suite 200, Waukesha, WI 53188-3969 | 2005-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336787126 | Nicole Lee Berg-johnson | Nurse Practitioner | 820 Crestwood Dr., Waukesha, WI 53188 | 2019-12-12 |
| 1013475706 | Rachel Mueller | Occupational Therapist | 29667 Summit Ave, S11, Waukesha, WI 53188 | 2019-03-12 |
| 1861962649 | Emily Elizabeth Seefeld | Occupational Therapy Assistant | 29667 Summit Ave S11, Waukesha, WI 53188 | 2018-12-05 |
| 1003393307 | Ashley Susan Callahan | Dental Hygienist | 711 W. Moreland Blvd., Suite 204, Waukesha, WI 53188 | 2018-07-19 |
| 1245741321 | Melissa Weir | Case Manager/Care Coordinator | 514 Riverview Avenue, Waukesha, WI 53188 | 2017-10-17 |
| 1093233629 | Patricia Marie Sombrio | Dental Hygienist | 711 Moreland Blvd 204, Waukesha, WI 53188 | 2017-09-04 |
| 1134660244 | Bdg of Wisconsin, Inc. | Behavioral Analyst | N19w2309 Riverwood Drive, Suite 350 Pmb 314, Waukesha, WI 53188 | 2017-03-09 |
| 1255888731 | Lynne Sarah Alva | Dental Hygienist | 711 Moreland Blvd, Suite 204, Waukesha, WI 53188 | 2016-09-01 |
| 1881069730 | Michelle Koch | Occupational Therapist | 29667 Summit Ave. S11, Waukesha, WI 53188 | 2015-12-03 |
| 1952711012 | Rhonda Schroeder | Dental Hygienist | W286 N991 Shepherds Way, Waukesha, WI 53188 | 2014-04-29 |
| Find all providers in zip 53188 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063634228 | Renner and Martin Dds Sc | Clinic/Center | 1111 Delafield St. #319, Waukesha, WI 53188-3407 | 2007-05-03 |
| 1801400338 | Tanty Family Dental | Clinic/Center | W249s3642 Center Rd, Waukesha, WI 53189-7364 | 2020-09-02 |
| 1659749778 | Hillcrest Family Dental LLC | Clinic/Center | 1751 E Main St, Waukesha, WI 53186-3940 | 2015-09-05 |
| 1316347826 | Smiles for Miles Family Dentistry, LLC | Clinic/Center | S22w22660 Broadway, Suite 2, Waukesha, WI 53186-8100 | 2014-09-03 |
| 1477952687 | Proven Dental LLC | Clinic/Center | 1700 Coral Dr, Waukesha, WI 53186-1483 | 2014-08-14 |
| 1417295163 | Stephanie Race D.d.s., S.c. | Clinic/Center | W247s3114 Prairie Ave, Waukesha, WI 53189-7321 | 2013-01-30 |
| 1841538139 | Sunset Dental Care, S.c. | Clinic/Center | W247s3114 Prairie Ave, Waukesha, WI 53189-7321 | 2013-01-22 |
| 1245578665 | Jeffrey O'brien, D.d.s., S.c. | Clinic/Center | W247s3114 Prairie Ave, Waukesha, WI 53189-7321 | 2013-01-18 |
| 1114282829 | Your Family Dentist, LLC | Clinic/Center | 411 N Grand Ave, Suite 103, Waukesha, WI 53186-4961 | 2012-07-09 |
| 1629241237 | Waukesha County Community Dental Clinic, Inc. | Clinic/Center | 210 Nw Barstow St, Suite 305, Waukesha, WI 53188-3771 | 2008-04-04 |
| Find all providers in WAUKESHA | ||||
Please comment or provide details below to improve the information on SUMMIT SQUARE DENTAL LLC.
| 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.