Northern Lakes Dental, LTD.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10677 Issued in MN

Legal business name

NORTHERN LAKES DENTAL, LTD.

Practice address

1108 Western Ave
Fergus Falls, MN 56537-4808

Phone

(218) 736-4000

Fax

(218) 736-0766

NPI assigned

Apr 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Scott Alan Wagnild, D. D. S.

Title

President

Phone

(218) 736-4000

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003035775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 WESTERN AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565374808",
            "telephone_number": "218-736-4000",
            "fax_number": "218-736-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 WESTERN AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565374808",
            "telephone_number": "218-736-4000",
            "fax_number": "218-736-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LAKES DENTAL, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNILD",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-736-4000",
        "authorized_official_credential": "D. D. S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Ann Nickolauson, LPN
• Charis Helen Nielsen, RN
• Dennis D. Nims, MSW
• Kristy Norenberg, MPH, RD
• Northern Lakes Dental - Riverfront, LLC
• Northern Lights Psychological Services P.a.
• Robert S Noyes, MD
• Tanner Nygaard
• Jerra Cori Nylund
• Brandi Ochoa

• General Practice Dentistry in Fergus Falls, MN
• Providers in Fergus Falls, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.