Active NPI
Clinton Lawrence Roberts, DDS
- General Practice Dentistry
- Pillager, MN
National Provider Identifier
1295837508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D10518
- Practice address
- 727 Buckskin Ave West
Pillager, MN 56473 - Phone
- (218) 746-4555
- Fax
- (218) 746-4558
- NPI assigned
- Sep 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D10518 | MN | Primary |
Addresses
Primary practice location
727 Buckskin Ave West
Pillager, MN 56473
Mailing address
13942 Grand Oaks CT.
Baxter, MN 56425
Phone (218) 746-4555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 14, 2013 through Nov 14, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pillager Country Dental LLC | General Practice | Past | Accepting new patients |
| Heidi Fletcher, PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295837508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13942 GRAND OAKS CT.",
"city": "BAXTER",
"state": "MN",
"postal_code": "56425",
"telephone_number": "218-746-4555",
"fax_number": "218-746-4558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "727 BUCKSKIN AVE WEST",
"city": "PILLAGER",
"state": "MN",
"postal_code": "56473",
"telephone_number": "218-746-4555",
"fax_number": "218-746-4558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "CLINTON",
"middle_name": "LAWRENCE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D10518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pillager, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.