DR. PETER DOMINIC BORDINI (NPI# 1609901388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609901388 |
| Entity Type | Individual |
| Full Name | DR. PETER DOMINIC BORDINI |
| Credential | DDS |
| Practice Address |
1711 Shawano Ave Green Bay WI 54303 |
| Practice Telephone | 9204949541 |
| Practice Fax Number | 9204942026 |
| Mailing Telephone | 9204949541 |
| Mailing Fax Number | 9204942026 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 1257G | WI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 33562200 | 05 |
| Street Address |
1711 SHAWANO AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303 |
| 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 |
| 1700105806 | Nicholas Mattila | Dentist | 1711 Shawano Ave, Green Bay, WI 54303-3215 | 2010-05-28 |
| 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 |
| 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 | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184240236 | Casey Nan Messer | Dentist | 2805 Libal St Ste B, Green Bay, WI 54301-2888 | 2020-06-24 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1275013641 | David Alan Pass | Dentist | 844 Willard Dr # A, Green Bay, WI 54304-5265 | 2018-08-15 |
| 1831691872 | Melanie Hammerbeck | Dentist | 1756 Cardinal Ln, Green Bay, WI 54313 | 2018-03-06 |
| 1114453024 | Juan Sebastian Munoz | Dentist | 709 S Oneida St Ste 6, Green Bay, WI 54304-2475 | 2017-05-11 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1043663321 | Thuy Nguyen | Dentist | 331 N Broadway, Green Bay, WI 54303-2701 | 2016-07-21 |
| 1629448170 | Simerjeet Kaur | Dentist | 1931 Main St, Green Bay, WI 54302-3920 | 2015-09-28 |
| 1811307408 | Adam Pasono | Dentist | 2313 S Webster Ave, Green Bay, WI 54301-2159 | 2014-05-05 |
| 1972764553 | S. Patrick Maraka | Dentist | 2830 Curry Ct Ste 1, Green Bay, WI 54311-4877 | 2008-06-17 |
| 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.