NPIMap

Organization Active NPI

Deerwood Orthodontics, LLC

Doing business as Deerwood Orthodontics Green Bay

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Green Bay, WI
National Provider Identifier
1689324493
Registry record updated Mar 25, 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 Green Bay
Practice address
2476 S Oneida St Ste 150
Green Bay, WI 54304-5292
Phone
(920) 593-9390
Fax
(920) 593-9398
NPI assigned
Mar 25, 2022
Last updated
Mar 25, 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 25, 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

2476 S Oneida St Ste 150
Green Bay, WI 54304-5292

Mailing address

2476 S Oneida St Ste 150
Green Bay, WI 54304-5292
Phone (920) 593-9390

Other names 1

  • Deerwood Orthodontics Green Bay 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.

NPI Registry JSON

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1689324493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2476 S ONEIDA ST STE 150",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045292",
            "telephone_number": "920-593-9390",
            "fax_number": "920-593-9398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2476 S ONEIDA ST STE 150",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045292",
            "telephone_number": "920-593-9390",
            "fax_number": "920-593-9398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEERWOOD ORTHODONTICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEERWOOD ORTHODONTICS, LLC",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-03-25",
        "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 Green Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 25, 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.