MEDICARE: DENTISTRY OF WISCONSIN

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	1223G0001X	General Practice Dentistry	2433	WI

General Provider Information

NPI Number	:	1437219417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY OF WISCONSIN

Provider Business Mailing Address
First Line	:	1260 W MAIN ST
Second Line	:	SUITE 1
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1930
Country	:	US
Telephone Number	:	608-834-8668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 W MAIN ST
Second Line	:	SUITE 1
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1930
Country	:	US
Telephone Number	:	608-834-8668
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES AMSTADT
Credential	:	DDS
Telephone Number	:	608-834-6321

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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Directions to “DENTISTRY OF WISCONSIN ” Practice Location

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