NPIMap

Organization Active NPI

Range Family Dental LLC

  • Dentist
  • Virginia, MN
National Provider Identifier
1104218239
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D12816 Issued in MN
Legal business name
RANGE FAMILY DENTAL LLC
Practice address
302 Chestnut St
Suite 200
Virginia, MN 55792-2541
Phone
(218) 741-0089
NPI assigned
Feb 26, 2015
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Jason Olai Berg, DDS
Title
Owner
Phone
(218) 741-0089

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D12816 MN Primary

Addresses

NPPES NPI Registry

Primary practice location

302 Chestnut St
Suite 200
Virginia, MN 55792-2541

Mailing address

302 Chestnut St
Suite 200
Virginia, MN 55792-2541
Phone (218) 741-0089

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 26, 2015.

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1104218239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 CHESTNUT ST",
            "address_2": "SUITE 200",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922541",
            "telephone_number": "218-741-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 CHESTNUT ST",
            "address_2": "SUITE 200",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922541",
            "telephone_number": "218-741-0089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANGE FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-26",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "OLAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-741-0089",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.