PARK-WEST PEDIATRIC DENTAL ASSOCIATES (NPI# 1730397233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730397233 |
| Entity Type | Organization |
| Organization Name | PARK-WEST PEDIATRIC DENTAL ASSOCIATES |
| Practice Address |
125 Siegler St Green Bay WI 54303-2635 |
| Practice Telephone | 9205928940 |
| Mailing Telephone | 9205928940 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. ERIC JAMES VAN MILLER (PEDIATRIC DENTIST) |
| Authorized Official Telephone | 9205928940 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
5182-015 | WI | Dental Providers |
| Street Address |
125 SIEGLER ST |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-2635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386672772 | James Joseph Conrardy I | Dentist | 125 Siegler St, Green Bay, WI 54303-2635 | 2006-06-28 |
| 1568752335 | Whitney Eichholz | Dentist | 125 Siegler St, Green Bay, WI 54303 | 2011-04-13 |
| 1649366790 | Meredith Evans | Dentist | 125 Siegler St, Green Bay, WI 54303-2635 | 2006-10-05 |
| 1861587982 | James Louis Van Miller | Dentist | 125 Siegler St, Green Bay, WI 54303 | 2006-10-04 |
| 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 | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346667045 | David Howard Jadin | Dentist | 1245 Main St, Green Bay, WI 54302 | 2014-03-20 |
| 1245302132 | Eric James Van Miller | Dentist | 125 Siegler Street, Green Bay, WI 54303 | 2006-11-15 |
| 1386672772 | James Joseph Conrardy I | Dentist | 125 Siegler St, Green Bay, WI 54303-2635 | 2006-06-28 |
| 1568752335 | Whitney Eichholz | Dentist | 125 Siegler St, Green Bay, WI 54303 | 2011-04-13 |
| 1649366790 | Meredith Evans | Dentist | 125 Siegler St, Green Bay, WI 54303-2635 | 2006-10-05 |
| 1861587982 | James Louis Van Miller | Dentist | 125 Siegler St, Green Bay, WI 54303 | 2006-10-04 |
| 1598789612 | William Joseph Kline | Dentist | 430 Main St, Green Bay, WI 54301-5115 | 2006-07-26 |
| 1235161514 | Heidi Eggers-ulve | Dentist | 1901 S Webster Ave, Suite 1, Green Bay, WI 54301-2281 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508478454 | New Richmond Kidds Pediatric Dentistry LLC | Dentist | 1244 N 4th St Ste 300, New Richmond, WI 54017-7540 | 2020-08-21 |
| 1710509484 | Hospital Dentistry for Kids Inc. | Dentist | 4980 S County Rd T, Denmark, WI 54208 | 2020-05-15 |
| 1467808592 | Alexis Colosimo | Dentist | 11035 W Forest Home Ave Ste 116, Hales Corners, WI 53130-2541 | 2016-05-07 |
| 1649676032 | Matina Angelopoulou | Dentist | 1801 West Winsconsin Ave, Milwaukee, WI 53233 | 2014-11-12 |
| 1407257108 | The Kids Dentist LLC | Dentist | 10618 N Port Washington Rd, Mequon, WI 53092-5013 | 2014-09-12 |
| 1144631698 | Jennifer Sinnen | Dentist | 14430 W Greenfield Ave, Brookfield, WI 53005-7036 | 2014-05-17 |
| 1396184370 | Adam Joseph Pamer | Dentist | 1320 S Green Bay Rd, Mt Pleasant, WI 53406-4406 | 2013-06-23 |
| 1255628491 | Ronald J Pruhs | Dentist | 4120 S Lake Dr, Apt. 251, Saint Francis, WI 53235-5954 | 2011-07-08 |
| 1982906525 | Jennifer Chun | Dentist | 100 River Pl Ste 110, Monona, WI 53716 | 2010-12-02 |
| 1043452758 | Barbara Lynn Phillips | Dentist | 8815 County Rd J, Woodruff, WI 54568-9636 | 2009-03-26 |
| Find all providers with the same taxonomy | ||||
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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.