NPIMap

Organization Active NPI

Edp of Wisconsin, SC

Doing business as Elite Dental Partners

  • Dental Clinic/Center
  • Chicago, IL
National Provider Identifier
1962961672
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
EDP OF WISCONSIN, SC
Doing business as
Elite Dental Partners
Parkside West Dental
Practice address
141 W Jackson Blvd
Chicago, IL 60604-2992
Phone
(312) 937-3619
NPI assigned
Mar 13, 2019
Last updated
Sep 16, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
EDP OF WISCONSIN, SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Authorized official

Name
Roseanne Brunenkant
Title
Director of Integrations
Phone
(312) 937-3619

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

141 W Jackson Blvd
Chicago, IL 60604-2992

Mailing address

141 W Jackson Blvd Ste 210
Chicago, IL 60604-3048
Phone (312) 937-3619

Other practice location 1

655 Deerwood Ave
Neenah, WI 54956-1629
Phone (312) 800-1270

Other names 2

  • Elite Dental Partners Doing business as
  • Parkside West Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Edp of Wisconsin SC4 organizations share this tax ID, including this one
Part of
Edp of Wisconsin SC

Other organizations with this tax ID 3

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

Locations

655 Deerwood Ave
Neenah, WI 54956
Phone (315) 657-2719

NPI Registry JSON

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

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568592000000",
    "number": "1962961672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W JACKSON BLVD STE 210",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606043048",
            "telephone_number": "312-937-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606042992",
            "telephone_number": "312-937-3619"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "655 Deerwood Ave",
            "address_purpose": "LOCATION",
            "city": "Neenah",
            "state": "WI",
            "postal_code": "549561629",
            "country_code": "US",
            "telephone_number": "312-800-1270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDP OF WISCONSIN, SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDP OF WISCONSIN, SC",
        "enumeration_date": "2019-03-13",
        "last_updated": "2019-09-16",
        "status": "A",
        "authorized_official_last_name": "BRUNENKANT",
        "authorized_official_first_name": "ROSEANNE",
        "authorized_official_title_or_position": "DIRECTOR OF INTEGRATIONS",
        "authorized_official_telephone_number": "312-937-3619"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dental Partners",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Parkside West Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; 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.