Keri Ishibashi, DMD
Individual provider Active NPI General Practice Dentistry · Bigfork, MN
NPI 1124512140 · NPPES record last updated Jan 8, 2021
Key facts
- NPI
- 1124512140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D14053 (MN)
- Practice address
- 303 Main St
Bigfork, MN 56628-2001 - Phone
- (218) 743-3600
- NPI assigned
- Jun 22, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14053 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook Area Health Services, Inc. | General Practice | Current |
Accepting new patients |
| Bloomington Smiles Dentistry, PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D14053 | MN | Yes |
Addresses
Primary practice location
303 Main St
Bigfork, MN 56628-2001
Mailing address
303 Main St
Bigfork, MN 56628-2001
Phone (218) 743-3600
Other providers in Bigfork, MN
- Suanne Marie Dullard
- Michalla Marie Dunaj-Compo
- Sara Ann Elioff
- Jessica Hazzard
- Christina Lynne Helterbrand
- Elizabeth Marie Jacobson
- Heidi Jean Korstad
- Jesse Lane
- Courtney Anne Loveridge
- Chelsea Mann
All providers in Bigfork, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.