Provider Demographics
NPI:1326173006
Name:DENTAL ARTS ASSOCIATES OF GREEN BAY LTD
Entity Type:Organization
Organization Name:DENTAL ARTS ASSOCIATES OF GREEN BAY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:FRIBERG WYCKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:920-494-9541
Mailing Address - Street 1:1711 SHAWANO AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303
Mailing Address - Country:US
Mailing Address - Phone:920-494-9541
Mailing Address - Fax:920-494-2026
Practice Address - Street 1:1711 SHAWANO AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-494-9541
Practice Address - Fax:920-494-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental