Provider Demographics
NPI:1609944644
Name:ISTHMUS DENTAL, LTD
Entity Type:Organization
Organization Name:ISTHMUS DENTAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-257-0116
Mailing Address - Street 1:122 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2120
Mailing Address - Country:US
Mailing Address - Phone:608-257-0116
Mailing Address - Fax:
Practice Address - Street 1:122 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2120
Practice Address - Country:US
Practice Address - Phone:608-257-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2469122300000X
WI5551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33406200Medicare ID - Type UnspecifiedDR. HEITKE MA PROVIDER #
WI33790400Medicare ID - Type UnspecifiedDR VU MEDICARE PROVIDE NO