NPIMap

Organization Active NPI

Advanced Dental Specialists, LLC

Doing business as Advanced Dental Specialists Bayshore

  • General Practice Dentistry
  • Glendale, WI
National Provider Identifier
1497403398
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ADVANCED DENTAL SPECIALISTS, LLC
Doing business as
Advanced Dental Specialists Bayshore
Practice address
500 W Silver Spring Dr Ste K250
Glendale, WI 53217-5062
Phone
(414) 529-5330
Fax
(414) 529-9552
NPI assigned
Mar 10, 2022
Last updated
Mar 10, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVANCED DENTAL SPECIALISTS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

500 W Silver Spring Dr Ste K250
Glendale, WI 53217-5062

Mailing address

500 W Silver Spring Dr Ste K250
Glendale, WI 53217-5062
Phone (414) 529-5330

Other names 1

  • Advanced Dental Specialists Bayshore Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dental Specialists LLC11 organizations share this tax ID, including this one
Part of
Advanced Dental Specialists LLC

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3030 N Ballard Rd
Appleton, WI 54911
Phone (920) 954-8085

9130 W Loomis Rd
Ste 700
Franklin, WI 53132
Phone (414) 427-6453

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1646870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1497403398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W SILVER SPRING DR STE K250",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175062",
            "telephone_number": "414-529-5330",
            "fax_number": "414-529-9552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W SILVER SPRING DR STE K250",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175062",
            "telephone_number": "414-529-5330",
            "fax_number": "414-529-9552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL SPECIALISTS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DENTAL SPECIALISTS, LLC",
        "enumeration_date": "2022-03-10",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Specialists Bayshore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; 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.