NPIMap

Organization Active NPI

Wisconsin Dental Group, S.C.

Doing business as ForwardDental Green Bay

  • General Practice Dentistry
  • Green Bay, WI
National Provider Identifier
1962532309
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Doing business as
ForwardDental Green Bay
Practice address
1241 Lombardi Access Rd Ste F
Green Bay, WI 54304-4059
Phone
(920) 498-9088
Fax
(920) 498-2146
NPI assigned
Mar 6, 2007
Organization subpart
Yes
Parent organization
WISCONSIN DENTAL GROUP, S.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 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
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1241 Lombardi Access Rd Ste F
Green Bay, WI 54304-4059

Mailing address

1241 Lombardi Access Rd Ste F
Green Bay, WI 54304-4059
Phone (920) 498-9088

Other names 1

  • ForwardDental Green Bay Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wi DTL GRP-HLS CRNS32 organizations share this tax ID, including this one
Part of
Wi DTL GRP-HLS CRNS

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

1241 Lombardi Access Rd
Ste F
Green Bay, WI 54304
Phone (920) 498-9088

1241 Lombardi Access Rd
Green Bay, WI 54304
Phone (920) 431-7120

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1962532309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 LOMBARDI ACCESS RD STE F",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044059",
            "telephone_number": "920-498-9088",
            "fax_number": "920-498-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 LOMBARDI ACCESS RD STE F",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044059",
            "telephone_number": "920-498-9088",
            "fax_number": "920-498-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN DENTAL GROUP, S.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WISCONSIN DENTAL GROUP, S.C.",
        "enumeration_date": "2007-03-06",
        "last_updated": "2022-03-14",
        "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": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForwardDental 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 14, 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.