Ronald G Mann, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

M-648 Issued in SD

Practice address

104 Philip Ave.
Philip, SD 57567-1003

Phone

(605) 859-2491

NPI assigned

Dec 27, 2007

Last updated

Dec 27, 2007By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kimberly a. Trask, D.D.S., Prof. L.L.C.

  • Dentist
  • Philip, SD
  • NPI 1518542927
  NPD (past)

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198713600000",
    "number": "1346424348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 1003",
            "address_2": "104 PHILIP AVE.",
            "city": "PHILIP",
            "state": "SD",
            "postal_code": "575671003",
            "telephone_number": "605-859-2491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 PHILIP AVE.",
            "city": "PHILIP",
            "state": "SD",
            "postal_code": "575671003",
            "telephone_number": "605-859-2491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANN",
        "first_name": "RONALD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-27",
        "last_updated": "2007-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "M-648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "780-4610",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David A Holman, M.D.
• Kimberly a. Trask, D.D.S., Prof. L.L.C.
• Courtney Larson Kjerstad, PHARM.D.
• Kayli Ellen Jean Kjerstad, RN
• Jenna M Maag, NP
• Robin R Peterson-Lund, CNP
• Philip Ambulance Service
• Philip Clinic (Phiip Clinic)
• Philip Health Services, Inc. (Hans P. Peterson Memorial Hospital)
• Philip Health Services, Inc. (Philip Home Health)

• General Practice Dentistry in Philip, SD
• Providers in Philip, SD by specialty
• General Practice Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; 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.