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CEDAR LAKE DENTAL PROFESSIONALS LTD
NPI 1790840734
Dentist - General Practice in West Bend, WI

Active since December 27, 2006
145 N 18TH AVENUE, WEST BEND, WI 53095(262) 334-3084(262) 334-3552 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 11, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About Cedar Lake Dental Professionals Ltd NPPES

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

CEDAR LAKE DENTAL PROFESSIONALS LTD (NPI 1790840734) is a healthcare organization registered as a general practice in West Bend, Wisconsin and active in the NPI registry since December 2006. The organization lists Lysette L Brueggeman, Owner, as its authorized official.

NPPES Registry Identity

NPI1790840734
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameCEDAR LAKE DENTAL PROFESSIONALS LTD
Location Address145 N 18TH AVENUEWest Bend, WI 53095
Mailing Address145 N 18th AvenueWest Bend, WI 53095 · (262) 334-3084 · Fax (262) 334-3552
Phone(262) 334-3084
Fax(262) 334-3552
Organization SubpartNo
Authorized OfficialLysette L BrueggemanOwner · (262) 334-3084
Enumeration DateDecember 27, 2006
Last NPPES UpdateSeptember 11, 20252 updates tracked since enumeration
✔ NPI 1790840734 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in WI · 4368
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.

Also ListedDentist · ProsthodonticsTaxonomy 1223P0700X · License 4408 (WI)

Other Identifiers 3

Other33761800WI · Medicaid
Medicaid33713000WI
Other650286United Concordia

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHAEL SCOTT KOPECKY DDS MS
Dentist (Prosthodontics)
145 N 18TH AVENUE
WEST BEND, WI 53095
Washington County (262) 334-3084
LYSETTE LUCILLE BRUEGGEMAN DDS
Dentist (General Practice)
145 N 18TH AVENUE
WEST BEND, WI 53095
Washington County (262) 334-3084

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 Cedar Lake Dental Professionals Ltd's NPI number?

The NPI number for Cedar Lake Dental Professionals Ltd is 1790840734. It was assigned to this organization in the NPPES registry on December 27, 2006.

Where is Cedar Lake Dental Professionals Ltd located?

Cedar Lake Dental Professionals Ltd is located at 145 N 18th Avenue, West Bend, WI 53095. The listed phone number is (262) 334-3084.

What is Cedar Lake Dental Professionals Ltd'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 Cedar Lake Dental Professionals Ltd was last updated on September 11, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.