Everaid Ubangoh Fokim, MDT

Primary specialty

Dental TherapistTaxonomy code 125J00000X

License

DT130 Issued in MN

Practice address

9920 Foley Blvd NW
Coon Rapids, MN 55433-4579

Phone

(763) 317-1166

NPI assigned

Sep 20, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1316617491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 7TH ST N",
            "city": "NORTH ST PAUL",
            "state": "MN",
            "postal_code": "551092845",
            "telephone_number": "165-180-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9920 FOLEY BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334579",
            "telephone_number": "763-317-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOKIM",
        "first_name": "EVERAID",
        "middle_name": "UBANGOH",
        "credential": "MDT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MN",
            "license": "H10783",
            "primary": false
        },
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "MN",
            "license": "DT130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Fletcher
• Danielle Fletcher, MSW, LICSW
• Verssy Siomara Flores Ortega
• John P Foderick, CRNA
• Milkeesso Foge, M.D.
• David V Folden, M.D.
• Sheila Kathryn Forbes, M.S.S.W.
• Teresa J Ford, CRNA
• Olga Formogey, CNP
• Kristin Dianne Forsythe, PT

• All providers in Coon Rapids, MN
• Dental Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.