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KENOSHA DENTIST LLC
NPI 1205364197
Dentist - General Practice in Kenosha, WI

Active since May 23, 2017
5455 SHERIDAN RD STE 201, KENOSHA, WI 53140(262) 244-0700 Get Directions Write a Review

NPPES record last updated: May 23, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kenosha Dentist Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENOSHA DENTIST LLC (NPI 1205364197) is a healthcare organization registered as a general practice in Kenosha, Wisconsin and active in the NPI registry since May 2017. The organization lists Dominic Kaczynski, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1205364197
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameKENOSHA DENTIST LLC
Location Address5455 SHERIDAN RD STE 201Kenosha, WI 53140-3752
Mailing Address5455 Sheridan Rd Ste 201Kenosha, WI 53140-3752
Phone(262) 244-0700
Organization SubpartNo
Authorized OfficialDominic KaczynskiBusiness Manager · (262) 244-0700
Enumeration DateMay 23, 2017
✔ NPI 1205364197 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
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.
5455 SHERIDAN RD STE 201, Kenosha, WI 53140
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Other Identifiers 1

Medicaid1699101477IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenosha Dentist LLC's NPI number?

The NPI number for Kenosha Dentist LLC is 1205364197. It was assigned to this organization in the NPPES registry on May 23, 2017.

Where is Kenosha Dentist LLC located?

Kenosha Dentist LLC is located at 5455 Sheridan Rd Ste 201, Kenosha, WI 53140. The listed phone number is (262) 244-0700.

What is Kenosha Dentist LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Kenosha Dentist LLC was last updated on May 23, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.