Edp of Wisconsin, SC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

EDP OF WISCONSIN, SC

Practice address

141 W Jackson Blvd
Chicago, IL 60604-2992

Phone

(312) 937-3619

NPI assigned

Mar 13, 2019

Organization subpart

Yes

Parent organization

EDP OF WISCONSIN, SCAs reported in NPPES

Name

Roseanne Brunenkant

Title

Director of Integrations

Phone

(312) 937-3619

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

• Edp of Wisconsin, PC

  • General Practice Dentistry
  • Milwaukee, WI
  • NPI 1932752862
  NPD tax ID
• Edp of Wisconsin, SC

  • Dental Clinic/Center
  • Oconomowoc, WI
  • NPI 1033671912
  NPD tax ID
• Edp of Wisconsin, SC

  • Dental Clinic/Center
  • Hartland, WI
  • NPI 1639685779
  NPD tax ID

Tax ID family

Edp of Wisconsin SC (4 organizations share this tax ID)

Part of

Edp of Wisconsin SC

Locations

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

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 16, 2019.

{
    "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"
        }
    ]
}

• Charles Edoigiawerie, M.D.
• Olivia Edoigiawerie
• Oluwakemi Magdalene Edoigiawerie, RN, MSN, FNP
• Sylvia Uwaila Edoigiawerie, MD-PHD
• Magnus E Edosomwan, MD
• Webster Montano Edpao, M.D.
• Michael L Edquiban, PT
• Laura Edquist
• Nekaela Edralin, DMD
• Kimberly Edstrom Schiller, M.S.

• All providers in Chicago, IL
• Dental Clinic/Center in Illinois

• 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.