Baycare Clinic, LLP
Dentist, Oral and Maxillofacial Surgery in Sturgeon Bay, WI. Organization (NPI-2).
NPI number1124516893
StatusActive
Last updated in NPPESAug 27, 2026
Details
- NPI
- 1124516893
- Entity type
- Organization (NPI-2)
- Legal business name
- Baycare Clinic, LLP
- Organization subpart
- No
- Enumeration date
- Apr 27, 2018
- Certification date
- Aug 27, 2026
- Last updated
- Aug 27, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | – | – | Yes |
Practice location
636 N 12th AveSturgeon Bay, WI 54235-1249
Phone 920-743-2001
Mailing address
Po Box 28900Green Bay, WI 54324-0900
Phone 920-490-9046 · Fax 920-405-5388
Authorized official
Taylor Konkle
Payor Enrollment
9203011327
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