WILLOW COVE DENTAL, LLC (NPI# 1801305271) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801305271 |
| Entity Type | Organization |
| Organization Name | WILLOW COVE DENTAL, LLC |
| Practice Address |
1195 W Mason St Green Bay WI 54303-2045 |
| Mailing Address |
1720 Congress Ave Oshkosh WI 54901-7701 |
| Practice Telephone | 9202353251 |
| Mailing Telephone | 9202353251 |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2017-09-28 |
| Authorized Official Name | WYN STECKBAUER (OWNER) |
| Authorized Official Telephone | 9202353251 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
5396-15 | WI | Ambulatory Health Care Facilities |
| Street Address |
1195 W MASON ST |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-2045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124127279 | Michael James Wallace | Dentist | 1195 W Mason St, Green Bay, WI 54303-2045 | 2006-09-22 |
| 1023670254 | Austin Allen Iverson | Dentist | 1195 W Mason St, Green Bay, WI 54303 | 2019-07-09 |
| 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 | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639568603 | Kenneth C. Clark Dds,ms | Clinic/Center | 2524 Hillside Heights Dr, Green Bay, WI 54311-6777 | 2015-01-14 |
| 1851423354 | Dr John J Quinlan S.c. | Clinic/Center | 2550 Glendale Ave, Green Bay, WI 54313-6849 | 2007-03-10 |
| 1225525959 | Meadowbrook Smiles | Clinic/Center | 2550 Glendale Ave, Green Bay, WI 54313-6849 | 2018-04-18 |
| 1861848293 | Echo Ridge Dental Clinic | Clinic/Center | 2140 S Ridge Rd, Green Bay, WI 54304-4357 | 2016-05-04 |
| 1972793818 | Northeast Wisconsin Technical College | Clinic/Center | 2740 W Mason St, Green Bay, WI 54303-4966 | 2007-07-26 |
| 1720118854 | Lombardi Dental, LLC | Clinic/Center | 1400 Lombardi Ave, Suite 50, Green Bay, WI 54304-3922 | 2007-03-07 |
| 1326173006 | Dental Arts Associates of Green Bay Ltd | Clinic/Center | 1711 Shawano Ave, Green Bay, WI 54303 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568063907 | Osceola Family Dental, Ltd | Clinic/Center | 215 N Cascade St, Osceola, WI 54020 | 2020-11-03 |
| 1578173985 | Bright Dental and Braces LLC | Clinic/Center | 3046 Fish Hatchery Rd, Fitchburg, WI 53713-3125 | 2020-08-01 |
| 1609493188 | Willow Dental Group LLC | Clinic/Center | 3333 S Sunnyslope Rd Ste 100, New Berlin, WI 53151-4504 | 2020-06-30 |
| 1447875711 | Iola Family Dental, LLC | Clinic/Center | 100 Pine Crest Ln, Iola, WI 54945-8230 | 2020-06-12 |
| 1073135331 | Oasis Dental LLC | Clinic/Center | 1037 S Cesar E Chavez Dr, Milwaukee, WI 53204-2204 | 2020-05-09 |
| 1679116685 | Mdc Milwaukee, LLC | Clinic/Center | 4701 W National Ave, Milwaukee, WI 53214-3521 | 2019-10-22 |
| 1982263893 | Schmidt Dental Holdings LLC | Clinic/Center | 7430 W Forest Home Ave, Greenfield, WI 53220-3358 | 2019-06-13 |
| 1124580352 | Upper Lakes Dental, LLC | Clinic/Center | 908 E Main St Ste C, Winneconne, WI 54986-9672 | 2019-04-05 |
| 1356808067 | Julia Fosterarmstrong | Clinic/Center | 335 Vernal Ave, Milton, WI 53563-1248 | 2019-02-28 |
| 1366907032 | Dr John M Kane Sc | Clinic/Center | 10317 N Greenwood Ln, Hayward, WI 54843-7167 | 2019-02-06 |
| 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.