NPIMap

Organization Active NPI

Fond Du Lac Reservation Business Committe

Doing business as Fond du Lac Human Services Division Dental Clinic

  • Dental Clinic/Center
  • Cloquet, MN
National Provider Identifier
1063723138
Registry record updated Jun 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
FOND DU LAC RESERVATION BUSINESS COMMITTE
Doing business as
Fond du Lac Human Services Division Dental Clinic
Practice address
927 Trettel Lane
Fond Du Lac Human Services Division Dental Clinic
Cloquet, MN 55720
Phone
(218) 879-1227
Fax
(218) 878-3755
NPI assigned
Jun 23, 2010
Last updated
Jun 23, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
FOND DU LAC RESERVATION BUSINESS COMMITTEEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2010

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

Authorized official

Name
Karen R Diver
Title
Chairwoman
Phone
(218) 879-4593

Specialties & licenses 1

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

Addresses

Primary practice location

927 Trettel Lane
Fond Du Lac Human Services Division Dental Clinic
Cloquet, MN 55720

Mailing address

927 Trettel Lane
Fond Du Lac Human Services Division Dental Clinic
Cloquet, MN 55720
Phone (218) 879-1227

Other identifiers 1

IdentifierTypeStateIssuer
666815100MedicaidMN

Other names 1

  • Fond du Lac Human Services Division Dental Clinic Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2151041Fond Du Lac Human Services Division -927 Trettel Lane, Cloquet, MN 55720Certificate of waiverJul 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
Arne Vaino MD8 organizations share this tax ID, including this one
Part of
Arne Vaino MD

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277251200000",
    "number": "1063723138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LANE",
            "address_2": "FOND DU LAC HUMAN SERVICES DIVISION DENTAL CLINIC",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LANE",
            "address_2": "FOND DU LAC HUMAN SERVICES DIVISION DENTAL CLINIC",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC RESERVATION BUSINESS COMMITTE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOND DU LAC RESERVATION BUSINESS COMMITTEE",
        "enumeration_date": "2010-06-23",
        "last_updated": "2010-06-23",
        "status": "A",
        "authorized_official_last_name": "DIVER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHAIRWOMAN",
        "authorized_official_telephone_number": "218-879-4593"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666815100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fond du Lac Human Services Division Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.