Great Plains Periodontics, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

1786 Issued in ND

Legal business name

GREAT PLAINS PERIODONTICS, PC

Practice address

2838 South University Drive
Fargo, ND 58103-6030

Phone

(701) 293-0577

Fax

(701) 293-0910

NPI assigned

Feb 6, 2009

Organization subpart

No

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

Authorized official

Name

Todd William Neils, D.D.S.

Title

President

Phone

(701) 293-0577

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1233878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233878400000",
    "number": "1093954570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2838 SOUTH UNIVERSITY DRIVE",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036030",
            "telephone_number": "701-293-0577",
            "fax_number": "701-293-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2838 SOUTH UNIVERSITY DRIVE",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036030",
            "telephone_number": "701-293-0577",
            "fax_number": "701-293-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT PLAINS PERIODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-06",
        "last_updated": "2009-02-06",
        "status": "A",
        "authorized_official_last_name": "NEILS",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-293-0577",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "ND",
            "license": "1786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Fargo, ND
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; 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.