Great Blue Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

5396-15 Issued in WI

Legal business name

GREAT BLUE DENTAL, LLC

Practice address

2005 Marinette Ave
Marinette, WI 54143-3864

Phone

(715) 732-2601

NPI assigned

Aug 26, 2016

Last updated

Aug 26, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Wyn Steckbauer, DMDNPI 1841391109

Title

Owner

Phone

(920) 235-3251

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Wyn Steckbauer, D.M.D.

  • Dentist
  • Oshkosh, WI
  • NPI 1841391109
  Authorized official Same address or phone
• Kurt A. Aschim, DDS

  • Dentist
  • Marinette, WI
  • NPI 1609023894
  NPD (past)

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472169600000",
    "number": "1720534159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 MARINETTE AVE",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 MARINETTE AVE",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433864",
            "telephone_number": "715-732-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT BLUE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2016-08-26",
        "status": "A",
        "authorized_official_last_name": "STECKBAUER",
        "authorized_official_first_name": "WYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-235-3251",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": "5396-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Goodwill Industries of Northern Wisconsin and Upper Michigan Inc.
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• Jacqueline A Gouge, APNP
• Erik K Graglia, OCCUPATIONAL THERAPI
• Alison Granquist, LCSW
• Great Lakes Heart and Vascular, LLC
• Nicholas Patrick Grimm, PA-C
• Brianna Grosso
• Terri Lynn Grun, LPN
• Melissa Guay, BSN, RN

• Dental Clinic/Center in Marinette, WI
• Providers in Marinette, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; 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.