| Organization Name: | CHILDREN'S DENTAL CLINIC OF GREEN BAY, S.C. |
| NPI Number: | 1205905619 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARGARET ANN MILLER (PEDIATRIC DENTIST) |
| Mailing Address: | 534 Redbird Cir De Pere |
| State: | WI US |
| Postal Code: | 541158785 |
| Phone Number: | 9203364002 |
| Fax Number: | 9203364112 |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 01/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 4176 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | 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. |