Winnebago Braces, LLC.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

WINNEBAGO BRACES, LLC.

Practice address

555 N Court St Ste 110
Rockford, IL 61103-6898

Phone

(815) 733-2550

NPI assigned

Jul 18, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Scott Goldman, DDS

Title

Ceo/Co-Founder

Phone

(312) 882-2569

Specialties & licenses 5

Addresses

Locations

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

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1952887374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4849 N MILWAUKEE AVE STE 403",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302169",
            "telephone_number": "312-946-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N COURT ST STE 110",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036898",
            "telephone_number": "815-733-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINNEBAGO BRACES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CEO/CO-FOUNDER",
        "authorized_official_telephone_number": "312-882-2569",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rickie Wilson, CRNA
• Shanika L Wilson, CNA
• Bethany Wiltshire, PT, MS
• Alexandra Wimberly
• Elaine M Winebrenner, PT
• Winnebago County Health Department
• Winnebago County Health Department
• Susan C Winterbauer, APN
• Alison Wintrode, LCPC
• Ashley Wire, FNP-BC

• Orthodontics and Dentofacial Orthopedics Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; 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.