Active NPI
John Clayton Withrow, DDS
- Endodontics
- Lake Elmo, MN
National Provider Identifier
1407915432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D11398
- Practice address
- 8650 Hudson Blvd N
Suite105
Lake Elmo, MN 55042-9747 - Phone
- (651) 636-1072
- Fax
- (651) 501-1471
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D11398 | MN | Primary |
Addresses
Primary practice location
8650 Hudson Blvd N
Suite105
Lake Elmo, MN 55042-9747
Mailing address
14801 Summit Oaks Dr
Burnsville, MN 55337-4789
Phone (952) 431-3548
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 |
|---|---|---|---|
| D11398 | MN | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407915432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14801 SUMMIT OAKS DR",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553374789",
"telephone_number": "952-431-3548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8650 HUDSON BLVD N",
"address_2": "SUITE105",
"city": "LAKE ELMO",
"state": "MN",
"postal_code": "550429747",
"telephone_number": "651-636-1072",
"fax_number": "651-501-1471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITHROW",
"first_name": "JOHN",
"middle_name": "CLAYTON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MN",
"license": "D11398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elmo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.