NPIMap

Organization Active NPI

Dakota Dental Associates PC

  • Dentist
  • Grand Forks, ND
National Provider Identifier
1417067919
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DAKOTA DENTAL ASSOCIATES PC
Practice address
4000 17TH Ave S
Grand Forks, ND 58201-3905
Phone
(701) 775-0641
Fax
(701) 746-9328
NPI assigned
Aug 30, 2006
Last updated
May 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

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

Authorized official

Name
Dr. Paul Thomas Bothun, DDSNPI 1295845790
Title
President - Owner
Phone
(701) 775-0641

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
Dentist 122300000X NU Primary

Addresses

Primary practice location

4000 17TH Ave S
Grand Forks, ND 58201-3905

Mailing address

4000 17TH Ave S
Grand Forks, ND 58201-3905
Phone (701) 775-0641

Other identifiers 1

IdentifierTypeStateIssuer
788399OtherUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

4000 17th Ave S
Grand Forks, ND 58201
Phone (701) 775-0641

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463961600000",
    "number": "1417067919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 17TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013905",
            "telephone_number": "701-775-0641",
            "fax_number": "701-746-9328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 17TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013905",
            "telephone_number": "701-775-0641",
            "fax_number": "701-746-9328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAKOTA DENTAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-05-23",
        "status": "A",
        "authorized_official_last_name": "BOTHUN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT - OWNER",
        "authorized_official_telephone_number": "701-775-0641",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "788399",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; 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.