NPIMap

Organization Active NPI

Dakota Dental Care

  • Dentist
  • Ellendale, ND
National Provider Identifier
1225443310
Registry record updated Dec 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2229 Issued in ND
Legal business name
DAKOTA DENTAL CARE
Practice address
210 Main Street
Ellendale, ND 58436
Phone
(701) 349-3636
NPI assigned
Jun 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2014

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

Authorized official

Name
Caleb JohnsenNPI 1457754004
Title
Dentist
Phone
(701) 349-3636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 1770 ND
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 2229 ND Primary

Addresses

Primary practice location

210 Main Street
Ellendale, ND 58436

Mailing address

PO Box 310
Ellendale, ND 58436-0310

Other identifiers 2

IdentifierTypeStateIssuer
040501MedicaidND
7850030MedicaidSD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1225443310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "ELLENDALE",
            "state": "ND",
            "postal_code": "584360310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 MAIN STREET",
            "city": "ELLENDALE",
            "state": "ND",
            "postal_code": "58436",
            "telephone_number": "701-349-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAKOTA DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSEN",
        "authorized_official_first_name": "CALEB",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "701-349-3636"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ND",
            "license": "1770",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ND",
            "license": "2229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040501",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7850030",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellendale, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.