Glacial Lakes Dental, PLLP

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GLACIAL LAKES DENTAL, PLLP

Practice address

509 16TH Ave SW
Willmar, MN 56201-4118

Phone

(320) 235-7742

Fax

(320) 235-4045

NPI assigned

Mar 17, 2011

Last updated

Mar 17, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Dawn Renae Platt

Title

Office Manager

Phone

(320) 235-7742

Specialties & licenses 1

Addresses

Locations

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.

• John Paul Iverson, DDS

  • General Practice Dentistry
  • Willmar, MN
  • NPI 1508817586
  NPD (past)
• Stephen Mark Medin, D.D.S.

  • Dentist
  • Willmar, MN
  • NPI 1801969803
  NPD (past)

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1184923096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 16TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014118",
            "telephone_number": "320-235-7742",
            "fax_number": "320-235-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 16TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014118",
            "telephone_number": "320-235-7742",
            "fax_number": "320-235-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIAL LAKES DENTAL, PLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "PLATT",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "RENAE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "320-235-7742",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle A Gerow-Ellis
• Elizabeth Geurtz
• Gillette Children's Specialty Healthcare (Gillette Children's Healthcare Willmar)
• Hannah Rose Gjerde, DPT
• Ruth Elaine Gjerde, LPN
• Tyler Goettl, MD
• Allison Jessica Goldenstein, DO
• Sharon Diane Goosmann, D.C.
• Nathan Goracke, PHARMD
• Carrie Grady, LPCC

• Dental Clinic/Center in Willmar, MN
• Providers in Willmar, 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 Mar 17, 2011; 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.