Active NPI
Mark J Juetten, DDS
- Dentist
- Cannon Falls, MN
National Provider Identifier
1184637753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- MN 7819
- Practice address
- 31378 Co 24 Blvd
Cannon Falls, MN 55009 - Phone
- (507) 263-3965
- Fax
- (507) 263-9485
- NPI assigned
- Aug 14, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | MN 7819 | MN | Primary |
Addresses
Primary practice location
31378 Co 24 Blvd
Cannon Falls, MN 55009
Mailing address
PO Box 15
Cannon Falls, MN 55009
Phone (507) 263-3965
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MN 7819 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Weber Family Dentistry LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Cannon Falls, MN
- NPI 1881997070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184637753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15",
"city": "CANNON FALLS",
"state": "MN",
"postal_code": "55009",
"telephone_number": "507-263-3965",
"fax_number": "507-263-9485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31378 CO 24 BLVD",
"city": "CANNON FALLS",
"state": "MN",
"postal_code": "55009",
"telephone_number": "507-263-3965",
"fax_number": "507-263-9485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUETTEN",
"first_name": "MARK",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "MN 7819",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cannon Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.