Jonathan Isak Siverson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12410 Issued in MN

Practice address

4700 White Bear Pkwy
White Bear Lake, MN 55110-3336

Phone

(651) 762-7677

Fax

(651) 762-1861

NPI assigned

Jun 12, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Isaacson Gentle Dentistry

  • Dental Clinic/Center
  • White Bear Lake, MN
  • NPI 1801037437
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205030491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1291 NILES AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161632",
            "telephone_number": "612-360-1713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103336",
            "telephone_number": "651-762-7677",
            "fax_number": "651-762-1861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVERSON",
        "first_name": "JONATHAN",
        "middle_name": "ISAK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gracia Ann Sich
• Meaza Angel Silva
• Maria Leora Amaro Simmons, PHARMD
• Simply Chiropractic Center, P.a.
• Kaile Hope Sinclair
• Kayla Jo Skeate, DNP, APRN, CPNP-PC
• Sarah Slattery, PA-C
• Laura Lenee Slings, MD
• Leah Marie Sluis
• Dennis A Smith, M.S.W.

• General Practice Dentistry in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• General Practice Dentistry in Minnesota

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.