Active NPI
Caitlin Spacek, DDS
- General Practice Dentistry
- Moorhead, MN
National Provider Identifier
1336765254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2404
- Practice address
- 2704 12TH St S
Moorhead, MN 56560-4621 - Phone
- (218) 233-0570
- NPI assigned
- Jun 17, 2020
- Last updated
- May 13, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D14526 | MN | |
| General Practice Dentistry | 1223G0001X | 2404 | ND | Primary |
Addresses
Primary practice location
2704 12TH St S
Moorhead, MN 56560-4621
Mailing address
1650 45TH St S Ste 108
Fargo, ND 58103-3247
Phone (701) 526-4652
Other practice location 1
3300 32nd Ave S
Grand Forks, ND 58201-5801
Phone (701) 765-3494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14526 | MN | MD | Dentist |
| 2404 | ND | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Krista Johnson DMD PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715558400000",
"number": "1336765254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 45TH ST S STE 108",
"city": "FARGO",
"state": "ND",
"postal_code": "581033247",
"telephone_number": "701-526-4652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2704 12TH ST S",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565604621",
"telephone_number": "218-233-0570"
}
],
"practiceLocations": [
{
"address_1": "3300 32nd Ave S",
"address_purpose": "LOCATION",
"city": "Grand Forks",
"state": "ND",
"postal_code": "582015801",
"country_code": "US",
"telephone_number": "701-765-3494",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SPACEK",
"first_name": "CAITLIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-17",
"last_updated": "2024-05-13",
"certification_date": "2024-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14526",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ND",
"license": "2404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.