NPIMap

Organization Active NPI

Blackduck Dental Clinic PSC

  • General Practice Dentistry
  • Blackduck, MN
National Provider Identifier
1376814939
Registry record updated Jan 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D12251 Issued in MN
Legal business name
BLACKDUCK DENTAL CLINIC PSC
Practice address
49 Summit Ave. E.
Blackduck, MN 56630-9727
Phone
(218) 835-4227
NPI assigned
Jan 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2012

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

Authorized official

Name
Dr. Scott Joseph Larson, DDSNPI 1952467466
Title
President
Phone
(218) 835-4227

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D12251 MN Primary

Addresses

Primary practice location

49 Summit Ave. E.
Blackduck, MN 56630-9727

Mailing address

PO Box 308
Blackduck, MN 56630-0308
Phone (218) 835-4227

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1326412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1376814939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "BLACKDUCK",
            "state": "MN",
            "postal_code": "566300308",
            "telephone_number": "218-835-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 SUMMIT AVE. E.",
            "city": "BLACKDUCK",
            "state": "MN",
            "postal_code": "566309727",
            "telephone_number": "218-835-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKDUCK DENTAL CLINIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-13",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-835-4227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackduck, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.