1295018190 NPI number — BRIDGET PILLER

Table of content: DR. GRAYSON STUART GRIFFIS D.M.D. (NPI 1912389784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295018190 NPI number — BRIDGET PILLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGET PILLER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295018190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 GRANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT ATKINSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53538-2219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 GRANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT ATKINSON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53538-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-988-8945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PILLER
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
REGISTERED NURSE
Authorized Official Telephone Number:
920-988-8945

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  176153-30 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)