NPIMap

Organization Active NPI

Sjulson Family Dentistry

  • Dentist
  • Fosston, MN
National Provider Identifier
1124386099
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8437 Issued in MN
Legal business name
SJULSON FAMILY DENTISTRY
Practice address
109 Johnson Ave. N
Fosston, MN 56542-1327
Phone
(218) 435-1599
Fax
(218) 435-6568
NPI assigned
Apr 30, 2012
Last updated
Apr 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

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

Authorized official

Name
Dr. Roger Wayne Sjulson, D.D.S.NPI 1720140841
Title
Dentist
Phone
(218) 435-1599

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 8437 MN Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X LGL5 MN

Addresses

Primary practice location

109 Johnson Ave. N
Fosston, MN 56542-1327

Mailing address

109 Johnson Ave N.
Fosston, MN 56542-1327
Phone (218) 435-1599

Other names 1

  • Dr. Sjulson's Dental Office Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1124386099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 JOHNSON AVE N.",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421327",
            "telephone_number": "218-435-1599",
            "fax_number": "218-435-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 JOHNSON AVE. N",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421327",
            "telephone_number": "218-435-1599",
            "fax_number": "218-435-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJULSON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "SJULSON",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "218-435-1599",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "8437",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "LGL5",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Sjulson's Dental Office",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fosston, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; 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.