FAMILIA DENTAL KENOSHA LLC (NPI# 1154782209) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154782209 |
| Entity Type | Organization |
| Organization Name | FAMILIA DENTAL KENOSHA LLC |
| Practice Address |
6430 Green Bay Rd Ste 112 Kenosha WI 53142-2948 |
| Mailing Address |
2050 E Algonquin Rd Suite 610 Schaumburg IL 60173-4144 |
| Practice Telephone | 8889884066 |
| Practice Fax Number | 8474964850 |
| Mailing Telephone | 8889884066 |
| Mailing Fax Number | 8474964850 |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2016-03-17 |
| Authorized Official Name | IVONNE TELLEZ (ENROLLMENT TEAM LEAD) |
| Authorized Official Telephone | 8889884066 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
6430 GREEN BAY RD STE 112 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-2948 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285287540 | Krupa M Patel | Dentist | 6430 Green Bay Rd, Kenosha, WI 53142-2948 | 2019-07-16 |
| 1720549660 | Prathi H Jain | Dentist | 6430 Green Bay Rd, Kenosha, WI 53142-2948 | 2019-03-25 |
| 1063910164 | Jasjot Chahil | Dentist | 6430 Green Bay Rd, Kenosha, WI 53142-2948 | 2018-01-24 |
| 1932625522 | Dong Song | Dentist | 6430 Green Bay Rd, Kenosha, WI 53142-2948 | 2017-08-16 |
| 1639626450 | Aidan Park | Dentist | 6430 Green Bay Rd, Kenosha, WI 53142-2948 | 2016-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| 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 |
|---|---|---|---|---|
| 1205364197 | Kenosha Dentist LLC | Dentist | 5455 Sheridan Rd Ste 201, Kenosha, WI 53140-3752 | 2017-05-23 |
| 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.