Great Northern Dental Care

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1688 Issued in ND

Legal business name

GREAT NORTHERN DENTAL CARE

Practice address

667 Demers Ave Ste 1002
Grand Forks, ND 58201-4500

Phone

(701) 772-8488

NPI assigned

Nov 20, 2015

Organization subpart

No

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

Authorized official

Name

Dr. John Clayburgh, DDS

Title

Doctor

Phone

(701) 772-8488

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447977600000",
    "number": "1356715841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "667 DEMERS AVE, STE 1002",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-772-8488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 DEMERS AVE STE 1002",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014500",
            "telephone_number": "701-772-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT NORTHERN DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-20",
        "last_updated": "2015-11-20",
        "status": "A",
        "authorized_official_last_name": "CLAYBURGH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "701-772-8488",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ND",
            "license": "1688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1456616",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Grassel, FNP-C
• Danielle Gratton, RN
• Marissa S Gravelle
• Elizabeth Gray, MD
• Charlie Greaf
• Greater Grand Forks Senior Citizens Assoc, Inc.
• Gregory D Greek, MD
• Cassady Green
• Mandi R Green, AUD
• Nialani Green, M.S.

• Clinic/Center in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; 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.