NPIMap

Organization Active NPI

Elk River Family Dentistry

  • Dentist
  • Elk River, MN
National Provider Identifier
1245303254
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ELK RIVER FAMILY DENTISTRY
Practice address
303 Main Street
Elk River, MN 55330
Phone
(763) 441-9181
Fax
(763) 441-3399
NPI assigned
Nov 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jerome Raymond Nyberg, DDSNPI 1407927353
Title
Owner
Phone
(763) 441-9181

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

303 Main Street
Elk River, MN 55330

Mailing address

303 Main Street
Elk River, MN 55330
Phone (763) 441-9181

National Provider Directory

National Provider Directory

Locations

303 Main St NW
Elk River, MN 55330
Phone (763) 441-9181

Practitioners & affiliated clinicians

Practitioners 8

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245303254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 MAIN STREET",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "55330",
            "telephone_number": "763-441-9181",
            "fax_number": "763-441-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 MAIN STREET",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "55330",
            "telephone_number": "763-441-9181",
            "fax_number": "763-441-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK RIVER FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NYBERG",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-441-9181",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk River, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.