NPIMap

Organization Active NPI

Echo Ridge Dental Clinic

  • General Practice Dentistry
  • Green Bay, WI
National Provider Identifier
1063622645
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ECHO RIDGE DENTAL CLINIC
Practice address
2140 S. Ridge Rd.
Green Bay, WI 54304
Phone
(920) 494-7464
Fax
(920) 494-7919
NPI assigned
May 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Raymond L Schneider III, DDS
Title
Owner-Dentist
Phone
92049474646

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X WI Primary

Addresses

Primary practice location

2140 S. Ridge Rd.
Green Bay, WI 54304

Mailing address

2140 S. Ridge Rd.
Green Bay, WI 54304
Phone (920) 494-7464

National Provider Directory

National Provider Directory
Tax ID family
Echo Ridge Dental Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063622645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 S. RIDGE RD.",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54304",
            "telephone_number": "920-494-7464",
            "fax_number": "920-494-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 S. RIDGE RD.",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54304",
            "telephone_number": "920-494-7464",
            "fax_number": "920-494-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECHO RIDGE DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHNEIDER",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER-DENTIST",
        "authorized_official_telephone_number": "92049474646",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; 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.