MEDICARE: WEST PRAIRIE DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1124900907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PRAIRIE DENTAL LLC

Provider Business Mailing Address
First Line	:	2630 IRONWOOD DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-8830
Country	:	US
Telephone Number	:	608-837-7842
Fax Number	:	608-318-8787

Provider Business Practice Location Address
First Line	:	2630 IRONWOOD DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-8830
Country	:	US
Telephone Number	:	608-837-7842
Fax Number	:	608-318-8787

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KELSEY LAUFENBERG
Credential	:
Telephone Number	:	608-837-7842

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	08/28/2025

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Directions to “WEST PRAIRIE DENTAL LLC ” Practice Location

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