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NPI 1972357838ActiveIndividual· Dentist, General Practice· Milwaukee, WI
Opted out of Medicare from April 2024 to April 2028. Dentist, General Practice in Milwaukee, Wisconsin, licensed in WI, with an NPI issued in April 2024.
Overview
| NPI | 1972357838 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Apr 16, 2024 |
| Last updated in NPPES | Apr 16, 2024 |
| Certified by provider | Apr 16, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | 83627-875 | WI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|---|
| Opt-out | Opted out Apr 18, 2024 – Apr 18, 2028 |
| Can order and refer | Yes |
During an opt-out period the provider sees Medicare patients only under private contracts, and Medicare does not pay claims for their services.
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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