Active NPI
Theodore A Brown, D.D.S.
- General Practice Dentistry
- Mohall, ND
National Provider Identifier
1114013604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1760
- Practice address
- 106 3Rd Ave SE
Mohall, ND 58761 - Phone
- (701) 756-6655
- NPI assigned
- Oct 4, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1760 | ND | Primary |
Addresses
Primary practice location
106 3Rd Ave SE
Mohall, ND 58761
Mailing address
P.O. Box 188
Mohall, ND 58761-0188
Phone (701) 756-6655
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41000 | Medicaid | ND | |
| 901760 | Other | ND | DENTAL SERVICE CORPORATIO |
| 879031 | Other | ND | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160224001887 | ND | Order and Referring Only - Dentist | 5395040687 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1760 | ND | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1114013604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 188",
"city": "MOHALL",
"state": "ND",
"postal_code": "587610188",
"telephone_number": "701-756-6655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 3RD AVE SE",
"city": "MOHALL",
"state": "ND",
"postal_code": "58761",
"telephone_number": "701-756-6655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "THEODORE",
"middle_name": "A",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ND",
"license": "1760",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41000",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL SERVICE CORPORATIO",
"identifier": "901760",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "879031",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mohall, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.