NPIMap

Organization Active NPI

Hancock Dental Clinic, PA

Doing business as Hancock and Chokio Dental

  • Dental Clinic/Center
  • Hancock, MN
National Provider Identifier
1003278870
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D10212 Issued in MN
Legal business name
HANCOCK DENTAL CLINIC, PA
Doing business as
Hancock and Chokio Dental
Practice address
657 Atlantic Ave
Hancock, MN 56244-2104
Phone
(320) 392-5300
Fax
(320) 392-5302
NPI assigned
Mar 22, 2016
Last updated
Mar 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

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

Authorized official

Name
Timothy J Carlson, D.D.S.NPI 1306931720
Title
Owner/President
Phone
(320) 392-5300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X D10212 MN Primary

Addresses

Primary practice location

657 Atlantic Ave
Hancock, MN 56244-2104

Mailing address

657 Atlantic Ave
PO Box 395
Hancock, MN 56244-2104
Phone (320) 392-5300

Other identifiers 1

IdentifierTypeStateIssuer
1306931720OtherMNNPI

Other names 1

  • Hancock and Chokio Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1003278870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 ATLANTIC AVE",
            "address_2": "PO BOX 395",
            "city": "HANCOCK",
            "state": "MN",
            "postal_code": "562442104",
            "telephone_number": "320-392-5300",
            "fax_number": "320-392-5302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 ATLANTIC AVE",
            "city": "HANCOCK",
            "state": "MN",
            "postal_code": "562442104",
            "telephone_number": "320-392-5300",
            "fax_number": "320-392-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANCOCK DENTAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "320-392-5300",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D10212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1306931720",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hancock and Chokio Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hancock, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.