NPIMap

Organization Active NPI

Deerwood Orthodontics, LLC

Doing business as Deerwood Orthodontics Bayshore

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Glendale, WI
National Provider Identifier
1669120259
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
DEERWOOD ORTHODONTICS, LLC
Doing business as
Deerwood Orthodontics Bayshore
Practice address
500 W Silver Spring Dr Ste K230
Glendale, WI 53217-5053
Phone
(414) 332-4900
Fax
(414) 332-4949
NPI assigned
Mar 14, 2022
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DEERWOOD ORTHODONTICS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 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
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU Primary

Addresses

Primary practice location

500 W Silver Spring Dr Ste K230
Glendale, WI 53217-5053

Mailing address

500 W Silver Spring Dr Ste K230
Glendale, WI 53217-5053
Phone (414) 332-4900

Other names 1

  • Deerwood Orthodontics Bayshore Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wisconsin Dental Groupsc10 organizations share this tax ID, including this one
Part of
Wisconsin Dental Groupsc

Other organizations with this tax ID 9

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

Locations

500 W Silver Spring Dr
Ste K230
Glendale, WI 53217
Phone (414) 332-4900

NPI Registry JSON

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

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1669120259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W SILVER SPRING DR STE K230",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175053",
            "telephone_number": "414-332-4900",
            "fax_number": "414-332-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W SILVER SPRING DR STE K230",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175053",
            "telephone_number": "414-332-4900",
            "fax_number": "414-332-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEERWOOD ORTHODONTICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEERWOOD ORTHODONTICS, LLC",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "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": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deerwood Orthodontics 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 14, 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.