NPIMap

Organization Active NPI

The Center for Dental Excellence, S.C.

  • General Practice Dentistry
  • Green Bay, WI
National Provider Identifier
1013124056
Registry record updated Mar 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4498-015 Issued in WI
Legal business name
THE CENTER FOR DENTAL EXCELLENCE, S.C.
Practice address
410 Security Blvd
Green Bay, WI 54313-9705
Phone
(920) 662-1440
Fax
(920) 662-1443
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David J. Brusky, D.D.S.NPI 1962619957
Title
President
Phone
(920) 662-1440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4498-015 WI Primary

Addresses

Primary practice location

410 Security Blvd
Green Bay, WI 54313-9705

Mailing address

410 Security Blvd
Green Bay, WI 54313-9705
Phone (920) 662-1440

Other identifiers 1

IdentifierTypeStateIssuer
33797600MedicaidWI

National Provider Directory

National Provider Directory

Locations

410 Security Blvd
Green Bay, WI 54313
Phone (920) 662-1440

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1013124056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 SECURITY BLVD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543139705",
            "telephone_number": "920-662-1440",
            "fax_number": "920-662-1443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 SECURITY BLVD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543139705",
            "telephone_number": "920-662-1440",
            "fax_number": "920-662-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR DENTAL EXCELLENCE, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2009-03-24",
        "status": "A",
        "authorized_official_last_name": "BRUSKY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-662-1440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4498-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33797600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.