Great River Orthodontic Specialists, SC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

GREAT RIVER ORTHODONTIC SPECIALISTS, SC

Doing business as

Ross Orthodontics

Practice address

2215 Vine St Ste B
Hudson, WI 54016-5862

Phone

(715) 808-8379

NPI assigned

Mar 7, 2022

Last updated

Mar 7, 2022By 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

Lori Amidon

Title

Patient Accounts MGR

Phone

(715) 598-7473

Specialties & licenses 1

Addresses

Other names 1

• Ross Orthodontics Doing business as

Locations

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

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1891442174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 OAKWOOD HILLS PKWY",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547017780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 VINE ST STE B",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540165862",
            "telephone_number": "715-808-8379"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "368 Lake St S Ste 101",
            "address_purpose": "LOCATION",
            "city": "Forest Lake",
            "state": "MN",
            "postal_code": "550252824",
            "country_code": "US",
            "telephone_number": "651-464-6988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT RIVER ORTHODONTIC SPECIALISTS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-07",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A",
        "authorized_official_last_name": "AMIDON",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS MGR",
        "authorized_official_telephone_number": "715-598-7473"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ross Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cynthia A Grajkowski, MS ED LMFT
• Gillian Grancorvitz, APRN, PMHNP
• Grandview Dental S.C.
• Dawn Marie Gray
• Great Lakes Oral & Maxillofacial Surgery, P.a.
• Paul Raymond Greeder, PHARMD
• Beverly Ann Green, MSSW
• Sarah Sue Greene, OTR/L
• Lindsey Ellen Grega, DPT
• Tami S Gregg

• Orthodontics and Dentofacial Orthopedics Dentistry in Hudson, WI
• Providers in Hudson, WI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.