NPIMap

Organization Active NPI

Bay Park Smiles LLC

  • General Practice Dentistry
  • Green Bay, WI
National Provider Identifier
1104543065
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BAY PARK SMILES LLC
Practice address
1052 Bel Aire CT
Green Bay, WI 54304-5015
Phone
(920) 499-2121
NPI assigned
Oct 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Authorized official

Name
Aaron BushongNPI 1871813329
Title
Dentist/Owner
Phone
(715) 573-3546

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1052 Bel Aire CT
Green Bay, WI 54304-5015

Mailing address

1052 Bel Aire CT
Green Bay, WI 54304-5015
Phone (920) 499-2121

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1104543065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 BEL AIRE CT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045015",
            "telephone_number": "920-499-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1052 BEL AIRE CT",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045015",
            "telephone_number": "920-499-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY PARK SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-21",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "BUSHONG",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "715-573-3546"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "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 Oct 21, 2022; 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.