NICHOLAS MATTILA (NPI# 1700105806) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700105806 |
| Entity Type | Individual |
| Full Name | NICHOLAS MATTILA |
| Credential | D.D.S. |
| Practice Address |
1711 Shawano Ave Green Bay WI 54303-3215 |
| Practice Telephone | 9204949541 |
| Practice Fax Number | 9204942026 |
| Mailing Telephone | 9204949541 |
| Mailing Fax Number | 9204942026 |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2013-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
7014-15 | WI | Dental Providers |
| Street Address |
1711 SHAWANO AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-3215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568597243 | Daniel Lloyd Baker Jr. | Dentist | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-22 |
| 1124326962 | Andrea Nicole Becks | Dental Hygienist | 1711 Shawano Ave, Green Bay, WI 54303-3215 | 2011-03-02 |
| 1932227311 | Lorie Ann Salentine | Dental Hygienist | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-03-26 |
| 1780711812 | Melissa Lynn Rukamp | Dental Hygienist | 1711 Shawano Ave, Green Bay, WI 54303-3215 | 2007-02-27 |
| 1588790489 | Lisa M Hekenberger | Dental Hygienist | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-26 |
| 1336274018 | Courtney Lynn Christensen | Dental Hygienist | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-22 |
| 1528193208 | Tami Jay Sargent | Dental Hygienist | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-22 |
| 1083749774 | Mark Robert Vande Walle | Dentist | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-22 |
| 1326173006 | Dental Arts Associates of Green Bay Ltd | Clinic/Center | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-22 |
| 1316072093 | Zachary Adam Graf | Dentist | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1386102465 | Parc Village Dental, LLC | Dentist | 2805 Libal Street, Suite A, Green Bay, WI 54301 | 2019-03-07 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1588197149 | Familia Dental West Green Bay | Dentist | 2280 W Mason St, Green Bay, WI 54303-4707 | 2017-04-10 |
| 1225489974 | Nicholas Van Ess | Dentist | 1640 Main St Stop 1, Green Bay, WI 54302-2639 | 2016-06-23 |
| 1063822328 | Jessica Leigh Pasono | Dentist | 2609 Development Dr, Green Bay, WI 54311 | 2014-05-07 |
| 1063622645 | Echo Ridge Dental Clinic | Dentist | 2140 S. Ridge Rd., Green Bay, WI 54304 | 2007-05-23 |
| 1710191085 | Lisa Rachel Piontek | Dentist | 526 S Monroe Ave, Green Bay, WI 54301-4018 | 2007-05-09 |
| 1831301290 | Family Dental Center of Green Bay, S.c. | Dentist | 2247 Fox Heights Ln, Green Bay, WI 54304-4747 | 2007-05-05 |
| 1194946079 | Kirk Richard Fishbaugh | Dentist | 2625 Tulip Ln, Green Bay, WI 54313-6855 | 2007-05-01 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.