NPIMap

Organization Active NPI

Mississippi Headwaters Area Dental Health Center, Inc.

Doing business as Northern Dental Access Center

  • Dental Clinic/Center
  • Bagley, MN
National Provider Identifier
1225811102
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MISSISSIPPI HEADWATERS AREA DENTAL HEALTH CENTER, INC.
Doing business as
Northern Dental Access Center
Practice address
13 Main Ave N
Bagley, MN 56621-8315
Phone
(218) 694-6571
NPI assigned
Aug 15, 2023
Last updated
Aug 15, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSISSIPPI HEADWATERS AREA DENTAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Erica Anne Lundberg, MBA
Title
Director of Finance and Operations
Phone
(218) 444-9147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

13 Main Ave N
Bagley, MN 56621-8315

Mailing address

1405 Anne St NW
Bemidji, MN 56601-5113
Phone (218) 444-9147

Other names 1

  • Northern Dental Access Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mississippi Headwaters Area Dental Health Center Inc4 organizations share this tax ID, including this one
Part of
Mississippi Headwaters Area Dental Health Center Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13 Main Ave N
Bagley, MN 56621
Phone (218) 694-6571

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1225811102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 ANNE ST NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015113",
            "telephone_number": "218-444-9147",
            "fax_number": "218-444-9252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 MAIN AVE N",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "566218315",
            "telephone_number": "218-694-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI HEADWATERS AREA DENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSISSIPPI HEADWATERS AREA DENTAL HEALTH CENTER",
        "enumeration_date": "2023-08-15",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "LUNDBERG",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE AND OPERATIONS",
        "authorized_official_telephone_number": "218-444-9147",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Dental Access Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bagley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; 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.