Paul Thomas Bothun, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

1791 Issued in ND

Practice address

Dakota Dental Associates PC
4000 17TH Ave S
Grand Forks, ND 58201-3905

Phone

(701) 775-0641

Fax

(701) 746-9328

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 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.

• Dakota Dental Associates PC

  • Dentist
  • Grand Forks, ND
  • NPI 1417067919
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620432000000",
    "number": "1295845790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DAKOTA DENTAL ASSOCIATES PC",
            "address_2": "4000 17TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013905",
            "telephone_number": "701-775-0641",
            "fax_number": "701-746-9328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DAKOTA DENTAL ASSOCIATES PC",
            "address_2": "4000 17TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013905",
            "telephone_number": "701-775-0641",
            "fax_number": "701-746-9328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTHUN",
        "first_name": "PAUL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-05-08",
        "certification_date": "2021-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ND",
            "license": "1791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "788399",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL SERVICES CORP",
            "identifier": "901791",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alycia Ann Bosco, MOTR/L
• Shantell Missouri Boston
• Annette Marie Bothun, PA-C
• Christopher Paul Bothun, DDS
• Erin Elizabeth Bothun
• Rachel Louise Bothun, DPT
• Brandi Boulduc
• Samantha Boulduc
• Christine Boulton-Olson, PHD
• Kristen Louise Boushee

• All providers in Grand Forks, ND
• Dentist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.