NPIMap

Organization Active NPI

Eastridge Dental Associates, S.C.

  • Dentist
  • Green Bay, WI
National Provider Identifier
1184775892
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
EASTRIDGE DENTAL ASSOCIATES, S.C.
Practice address
2343 E Mason St
Green Bay, WI 54302-3764
Phone
(920) 468-8144
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Authorized official

Name
Dr. John E. Patrickus, DDSNPI 1497912984
Title
President
Phone
(920) 468-8144

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2343 E Mason St
Green Bay, WI 54302-3764

Mailing address

2343 E. Mason Street
Green Bay, WI 54302
Phone (920) 468-8144

Other names 1

  • Eastridge Dental Doing business as

National Provider Directory

National Provider Directory

Locations

2343 E Mason St
Green Bay, WI 54302
Phone (920) 468-4646

Practitioners & affiliated clinicians

Practitioners 2

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1184775892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2343 E. MASON STREET",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54302",
            "telephone_number": "920-468-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2343 E MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543023764",
            "telephone_number": "920-468-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTRIDGE DENTAL ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "PATRICKUS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-468-8144",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastridge Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 1, 2008; 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.