NPIMap

Organization Active NPI

Edp of Wisconsin, SC

  • Dental Clinic/Center
  • Hartland, WI
National Provider Identifier
1639685779
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
EDP OF WISCONSIN, SC
Practice address
600 Hartbrook Dr Stop 7
Hartland, WI 53029-1436
Phone
(262) 367-0680
NPI assigned
Dec 27, 2017
Last updated
Sep 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Authorized official

Name
Melissa Garibay
Title
Credentialing Manager
Phone
(312) 736-8963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

600 Hartbrook Dr Stop 7
Hartland, WI 53029-1436

Mailing address

141 W Jackson Blvd Ste 210
Chicago, IL 60604-3048
Phone (312) 937-3619

Other practice location 1

7425 Main St W
Webster, WI 54893-8207
Phone (715) 866-4204

Other practice location 2

820 Summit Ave
Oconomowoc, WI 53066-3973
Phone (262) 567-4466

Other practice location 3

655 Deerwood Ave
Neenah, WI 54956-1629
Phone (920) 727-9595

Other practice location 4

1825 N Martin Luther King Dr
Milwaukee, WI 53212-3673
Phone (414) 372-7374

Other practice location 5

6121 7th Ave
Kenosha, WI 53143-4506
Phone (262) 654-6535

Other practice location 6

302 S Pine St
Grantsburg, WI 54840-7930
Phone (715) 463-2882

Other practice location 7

7020 N Port Washington Rd Ste 216
Glendale, WI 53217-3800
Phone (414) 964-0680

Other practice location 8

17160 W North Ave Ste 101
Brookfield, WI 53005-4437
Phone (262) 782-1655

Other practice location 9

141 W Jackson Blvd Ste 210
Chicago, IL 60604-3048
Phone (312) 736-8963

National Provider Directory

National Provider Directory
Tax ID family
Edp of Wisconsin SC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

17160 W North Ave
Ste 101
Brookfield, WI 53005
Phone (262) 782-1655

7020 N Port Washington Rd
Ste 216
Glendale, WI 53217
Phone (414) 964-0680

302 S Pine St
Grantsburg, WI 54840
Phone (715) 463-2882

600 Hartbrook Dr
Stop 7
Hartland, WI 53029
Phone (262) 367-0680

6121 7th Ave
Kenosha, WI 53143
Phone (262) 654-6535

105 W Silver Spring Dr
Whitefish Bay, WI 53217
Phone (414) 964-0680

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1514332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1639685779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W JACKSON BLVD STE 210",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606043048",
            "telephone_number": "312-937-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HARTBROOK DR STOP 7",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530291436",
            "telephone_number": "262-367-0680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7425 Main St W",
            "address_purpose": "LOCATION",
            "city": "Webster",
            "state": "WI",
            "postal_code": "548938207",
            "country_code": "US",
            "telephone_number": "715-866-4204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 Summit Ave",
            "address_purpose": "LOCATION",
            "city": "Oconomowoc",
            "state": "WI",
            "postal_code": "530663973",
            "country_code": "US",
            "telephone_number": "262-567-4466",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "655 Deerwood Ave",
            "address_purpose": "LOCATION",
            "city": "Neenah",
            "state": "WI",
            "postal_code": "549561629",
            "country_code": "US",
            "telephone_number": "920-727-9595",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1825 N Martin Luther King Dr",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532123673",
            "country_code": "US",
            "telephone_number": "414-372-7374",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6121 7th Ave",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531434506",
            "country_code": "US",
            "telephone_number": "262-654-6535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "302 S Pine St",
            "address_purpose": "LOCATION",
            "city": "Grantsburg",
            "state": "WI",
            "postal_code": "548407930",
            "country_code": "US",
            "telephone_number": "715-463-2882",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7020 N Port Washington Rd Ste 216",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "WI",
            "postal_code": "532173800",
            "country_code": "US",
            "telephone_number": "414-964-0680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17160 W North Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Brookfield",
            "state": "WI",
            "postal_code": "530054437",
            "country_code": "US",
            "telephone_number": "262-782-1655",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "141 W Jackson Blvd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606043048",
            "country_code": "US",
            "telephone_number": "312-736-8963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDP OF WISCONSIN, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-27",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "GARIBAY",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "312-736-8963"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartland, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.