NPIMap

Organization Active NPI

Allouez Family Dental Center SC

  • General Practice Dentistry
  • Green Bay, WI
National Provider Identifier
1477639102
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1857-G Issued in WI
Legal business name
ALLOUEZ FAMILY DENTAL CENTER SC
Practice address
2805 Libal St
Ste C
Green Bay, WI 54301-2788
Phone
(920) 339-8980
Fax
(920) 339-0133
NPI assigned
Oct 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Paul A Kollath, DDSNPI 1447315460
Title
President
Phone
(920) 339-8980

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
General Practice Dentistry 1223G0001X 1857-G WI Primary

Addresses

Primary practice location

2805 Libal St
Ste C
Green Bay, WI 54301-2788

Mailing address

2805 Libal St
Ste C
Green Bay, WI 54301-2877

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477639102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 LIBAL ST",
            "address_2": "STE C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012877",
            "fax_number": "920-339-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 LIBAL ST",
            "address_2": "STE C",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543012788",
            "telephone_number": "920-339-8980",
            "fax_number": "920-339-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLOUEZ FAMILY DENTAL CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOLLATH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-339-8980",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1857-G",
            "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 22, 2020; 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.