Children's Dental Clinic of Green Bay, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CHILDREN'S DENTAL CLINIC OF GREEN BAY, LLC

Practice address

534 Redbird Cir
De Pere, WI 54115-8785

Phone

(920) 336-4002

NPI assigned

Feb 13, 2023

Last updated

Feb 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kaitlin Haws

Title

Insurance Coordinator

Phone

(920) 336-4002

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Vijayalakshmi Shetty

  • Pediatric Dentistry
  • De Pere, WI
  • NPI 1215094750
  NPD
• Margaret Ann Miller, DDS

  • Pediatric Dentistry
  • De Pere, WI
  • NPI 1558665372
  NPD (past)

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

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676246400000",
    "number": "1306543095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "534 REDBIRD CIR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541158785",
            "telephone_number": "920-336-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 REDBIRD CIR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541158785",
            "telephone_number": "920-336-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTAL CLINIC OF GREEN BAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A",
        "authorized_official_last_name": "HAWS",
        "authorized_official_first_name": "KAITLIN",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "920-336-4002"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CCP Clinic, LLC
• Jessica M Champeau, PT
• Wendy L Chaput, LPC
• Morgan Chase, OT
• Manisha Chaturvedi, MD
• Children's Dental Clinic of Green Bay, S.C.
• Rand Chubin
• Rose M Cipres-Jaucian, MD
• City of de Pere
• City of de Pere (City of De Pere Ambulance Service)

• Pediatric Dentistry in De Pere, WI
• Providers in De Pere, WI by specialty
• Pediatric Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.