John D. Nydahl, DDS, P. a.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D8204 Issued in MN

Legal business name

JOHN D. NYDAHL, DDS, P. A.

Practice address

1011 2ND St N Ste 101
Saint Cloud, MN 56303-3237

Phone

(320) 253-0744

Fax

(320) 253-9930

NPI assigned

Jul 27, 2006

Organization subpart

No

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

Authorized official

Name

John D. Nydahl, DDSNPI 1508869371

Title

President

Phone

(320) 253-0744

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• John David Nydahl, D.D.S.

  • Endodontics
  • Saint Cloud, MN
  • NPI 1508869371
  NPD (past) Authorized official

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174547855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 2ND ST N STE 101",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033237",
            "telephone_number": "320-253-0744",
            "fax_number": "320-253-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 2ND ST N STE 101",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033237",
            "telephone_number": "320-253-0744",
            "fax_number": "320-253-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN D. NYDAHL, DDS, P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NYDAHL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-253-0744",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D8204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "55162NY",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "D8204",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Amelia Jindra, REGISTERED NURSE
• Jka5 Enterprises
• Megann A. Jobin
• Mariah Lynn Johannes
• Tammy Carol Johannes, RBT
• Alan Paul Johnson, PA-C
• Anna Carol Johnson, PA-C
• Benjamin Keith Johnson, MD
• Bradley Duaine Johnson, BES
• Courtney Michelle Johnson

• Dental Clinic/Center in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.