NPIMap

Organization Active NPI

North Main Family Dentistry LLC

  • General Practice Dentistry
  • Brookings, SD
National Provider Identifier
1053050336
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NORTH MAIN FAMILY DENTISTRY LLC
Practice address
717 Main Ave
Brookings, SD 57006-1426
Phone
(605) 692-4715
Fax
(605) 692-2427
NPI assigned
Jun 3, 2022
Last updated
Jun 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Authorized official

Name
Jeanne Myers
Title
Credentialing Coordinator
Phone
(605) 884-9341

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

717 Main Ave
Brookings, SD 57006-1426

Mailing address

2810 Riveridge LN
Green Bay, WI 54313-9535
Phone (920) 530-0022

National Provider Directory

National Provider Directory
Tax ID family
Day One Dentures Implants LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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": "1654214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1053050336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 RIVERIDGE LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543139535",
            "telephone_number": "920-530-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 MAIN AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570061426",
            "telephone_number": "605-692-4715",
            "fax_number": "605-692-2427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MAIN FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-03",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "605-884-9341"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.