EMILY DRIESENGA, EFDA — NPI 1710890900 (Licensed & Credentialed Dental Assistant in OCONTO, WI)

CMS-1500 Box 24J / 33a • NPI

1710890900

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

126800000X

Licensed & Credentialed Dental Assistant

Box 32 Service Location & ZIP+4

155 MEMORIAL DR, OCONTO, WI, 54153-2053

✓ 9-Digit EDI 837 ZIP+4 (54153-2053)

Practice Phone & Referral Fax

(920) 516-7107

Fax: (920) 516-1940

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1710890900 (EMILY DRIESENGA, EFDA) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1710890900` (NPI-1 Individual Practitioner)
Provider / Legal Name	EMILY DRIESENGA, EFDA
Plain-English Specialty	Licensed & Credentialed Dental Assistant NUCC Code: `126800000X` (Dental Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	155 MEMORIAL DR, OCONTO, WI, 54153-2053
Practice Telephone / Fax	Tel: (920) 516-7107 \| Fax: (920) 516-1940
Administrative Mailing Address	155 MEMORIAL DR, OCONTO, WI, 54153-2053
Enumeration & Last Sync	Enumerated: 2026-09-28 \| CMS Record Updated: 2026-09-28

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

155 MEMORIAL DR, OCONTO, WI, 54153-2053

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Plain-English Taxonomy & CMS Crosswalk (126800000X)

What Does Taxonomy Code 126800000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 126800000X translates to:
"Licensed & Credentialed Dental Assistant"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Dental Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (EMILY DRIESENGA, EFDA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`126800000X` — Dental Assistant Plain English: Licensed & Credentialed Dental Assistant	State: WI \| License: `50149-116` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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EMILY DRIESENGA, EFDA (NPI #1710890900)