Active NPI
Alicia Nicole Gendron, RDH
- Dental Hygienist
- Green Bay, WI
National Provider Identifier
1467934851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 1003347-16
- Practice address
- 2280 W Mason St
Green Bay, WI 54303-4707 - Phone
- (920) 321-3501
- NPI assigned
- Aug 31, 2018
- Last updated
- Aug 31, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 1003347-16 | WI | Primary |
Addresses
Primary practice location
2280 W Mason St
Green Bay, WI 54303-4707
Mailing address
350 S Peck Ave
Peshtigo, WI 54157-1511
Phone (906) 285-3545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1003347-16 | WI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535673600000",
"number": "1467934851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 S PECK AVE",
"city": "PESHTIGO",
"state": "WI",
"postal_code": "541571511",
"telephone_number": "906-285-3545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2280 W MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543034707",
"telephone_number": "920-321-3501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENDRON",
"first_name": "ALICIA",
"middle_name": "NICOLE",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-31",
"last_updated": "2018-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WI",
"license": "1003347-16",
"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 Aug 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.