NPIMap

Organization Active NPI

Boys and Girls Club of Portage County

  • Dental Hygienist
  • Stevens Point, WI
National Provider Identifier
1962916650
Registry record updated Nov 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
10047-16 Issued in WI
Legal business name
BOYS AND GIRLS CLUB OF PORTAGE COUNTY
Practice address
941 Michigan Ave
Stevens Point, WI 54481
Phone
(715) 204-1180
NPI assigned
Nov 17, 2017
Last updated
Nov 17, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2017

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

Authorized official

Name
Melissa Gutierrez, RDHNPI 1568980274
Title
Smile Club Coordinator
Phone
(715) 204-1180

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
Dental HygienistGroup: 193400000X SINGLE SPECIALTY GROUP 124Q00000X 10047-16 WI Primary

Addresses

Primary practice location

941 Michigan Ave
Stevens Point, WI 54481

Mailing address

PO Box 171
Stevens Point, WI 54481

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1510876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1962916650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 171",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "54481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 MICHIGAN AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "54481",
            "telephone_number": "715-204-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS AND GIRLS CLUB OF PORTAGE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-17",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "SMILE CLUB COORDINATOR",
        "authorized_official_telephone_number": "715-204-1180",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Hygienist",
            "state": "WI",
            "license": "10047-16",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stevens Point, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; 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.