Active NPI
Pedar Braden Didriksen, DDS
- Dentist
- Berlin, MD
National Provider Identifier
1093890436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7825
- Practice address
- 11310 Manklin Creek Rd Unit 5
Berlin, MD 21811-4013 - Phone
- (410) 208-2900
- Fax
- (410) 208-3285
- NPI assigned
- Oct 26, 2006
- Last updated
- Mar 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7825 | IA | Primary |
Addresses
Primary practice location
11310 Manklin Creek Rd Unit 5
Berlin, MD 21811-4013
Mailing address
907 Rainbow Dr
Cedar Falls, IA 50613
Phone (319) 277-7441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7825 | IA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553212800000",
"number": "1093890436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "907 RAINBOW DR",
"city": "CEDAR FALLS",
"state": "IA",
"postal_code": "50613",
"telephone_number": "319-277-7441",
"fax_number": "319-553-0607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11310 MANKLIN CREEK RD UNIT 5",
"city": "BERLIN",
"state": "MD",
"postal_code": "218114013",
"telephone_number": "410-208-2900",
"fax_number": "410-208-3285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIDRIKSEN",
"first_name": "PEDAR",
"middle_name": "BRADEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2019-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "7825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berlin, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.