Marissa Renee Bunge, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6001194 Issued in WI

Practice address

644 W Oshkosh St
Ripon, WI 54971-1001

Phone

(920) 748-6122

NPI assigned

Mar 30, 2023

Last updated

Jun 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hillside Dental Associates

  • General Practice Dentistry
  • Ripon, WI
  • NPI 1396765640
  NPD (past)

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

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1144924218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W13233 PENNY LN",
            "city": "RIPON",
            "state": "WI",
            "postal_code": "549719586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 W OSHKOSH ST",
            "city": "RIPON",
            "state": "WI",
            "postal_code": "549711001",
            "telephone_number": "920-748-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNGE",
        "first_name": "MARISSA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-30",
        "last_updated": "2023-06-21",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6001194",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karl J Bertram, MD
• Bio-Medical Applications of Wisconsin, Inc. (FMC Dialysis Services Ripon)
• Bio-Medical Applications of Wisconsin, Inc. (Fresenius Medical Care Ripon South)
• Joann Patricia Borkenhagen, NP-C
• David F Brown, MD
• Ratna Bunger, PHARMD
• Jason H Buttke, RPH
• David Alexis Calderwood, M.D.
• Andrew T Christenson, RPH
• Patrick Christopherson, PT, DPT

• General Practice Dentistry in Ripon, WI
• Providers in Ripon, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.