NPIMap

Organization Active NPI

Kids Dental Experts Partnership, LLC

  • Pediatric Dentistry
  • Green Bay, WI
National Provider Identifier
1730397233
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5182-015 Issued in WI
Legal business name
KIDS DENTAL EXPERTS PARTNERSHIP, LLC
Practice address
125 Siegler Street
Green Bay, WI 54303
Phone
(920) 592-8940
Fax
(920) 592-8953
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Authorized official

Name
Dr. Eric J. Van Miller, DDSNPI 1245302132
Title
Owner Doctor
Phone
(920) 592-8940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 5182-015 WI Primary

Addresses

Primary practice location

125 Siegler Street
Green Bay, WI 54303

Mailing address

125 Siegler Street
Green Bay, WI 54303
Phone (920) 592-8940

Other names 2

  • Kids Dental Experts Doing business as
  • Park-west Pediatric Dental Associates Former legal business name

National Provider Directory

National Provider Directory

Locations

125 Siegler St
Green Bay, WI 54303
Phone (920) 592-8940

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1730397233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 SIEGLER STREET",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54303",
            "telephone_number": "920-592-8940",
            "fax_number": "920-592-8953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 SIEGLER STREET",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54303",
            "telephone_number": "920-592-8940",
            "fax_number": "920-592-8953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS DENTAL EXPERTS PARTNERSHIP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "VAN MILLER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "920-592-8940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "5182-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Dental Experts",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Park-west Pediatric Dental Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Park-west Pediatric Dental Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jul 19, 2024; 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.