NPIMap

Organization Active NPI

Pine River Dental Center LLC

  • General Practice Dentistry
  • Pine River, MN
National Provider Identifier
1265845937
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D13393 Issued in MN
Legal business name
PINE RIVER DENTAL CENTER LLC
Practice address
203 Park Ave W
Pine River, MN 56474-4495
Phone
(218) 587-4438
NPI assigned
Jun 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Authorized official

Name
Dr. Jaime Preble
Title
General Dentist
Phone
(218) 587-4438

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D13393 MN Primary

Addresses

Primary practice location

203 Park Ave W
Pine River, MN 56474-4495

Mailing address

PO Box 650
Pine River, MN 56474-0650

National Provider Directory

National Provider Directory
Tax ID family
Pine River Dental Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1265845937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650",
            "city": "PINE RIVER",
            "state": "MN",
            "postal_code": "564740650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 PARK AVE W",
            "city": "PINE RIVER",
            "state": "MN",
            "postal_code": "564744495",
            "telephone_number": "218-587-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIVER DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "PREBLE",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "218-587-4438",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine River, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.