Bay Oral Surgery & Implant Center, LTD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

BAY ORAL SURGERY & IMPLANT CENTER, LTD

Practice address

2353 S Ridge Road
Green Bay, WI 54304

Phone

(920) 499-0471

Fax

(920) 499-8312

NPI assigned

May 3, 2007

Last updated

Dec 16, 2014By 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

Ellen M Greene

Title

Practice Adminstrat

Phone

(920) 499-0471

Specialties & licenses 1

Addresses

Other names 1

• Bay Oral & Maxillofacial Surgery, LTD Former legal business name

Locations

Practitioners 3

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.

• Ardit Haxhia, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Green Bay, WI
  • NPI 1427638170
  NPD (past)
• Timothy Jason Lemoine, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Green Bay, WI
  • NPI 1093394777
  NPD (past)
• Trystan Richard Wiedow, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Green Bay, WI
  • NPI 1427639038
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1427270776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 S RIDGE ROAD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54304",
            "telephone_number": "920-499-0471",
            "fax_number": "920-499-8312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2353 S RIDGE ROAD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54304",
            "telephone_number": "920-499-0471",
            "fax_number": "920-499-8312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY ORAL SURGERY & IMPLANT CENTER, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE ADMINSTRAT",
        "authorized_official_telephone_number": "920-499-0471"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Oral & Maxillofacial Surgery, LTD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; 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.