NPIMap

Organization Active NPI

Erickson/Aamodt Orthodontics, P.a.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • White Bear Lake, MN
National Provider Identifier
1417115189
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D9558 Issued in MN
Legal business name
ERICKSON/AAMODT ORTHODONTICS, P.A.
Practice address
4790 White Bear Pkwy
White Bear Lake, MN 55110-3336
Phone
(651) 426-3873
Fax
(651) 653-5790
NPI assigned
May 29, 2008
Last updated
May 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2008

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

Authorized official

Name
Dr. Keith Robert Erickson, DDS
Title
President
Phone
(651) 426-3873

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X D9558 MN Primary

Addresses

Primary practice location

4790 White Bear Pkwy
White Bear Lake, MN 55110-3336

Mailing address

4790 White Bear Pkwy
White Bear Lake, MN 55110-3336
Phone (651) 426-3873

National Provider Directory

National Provider Directory
Tax ID family
Ericksonaamodt Orthodontics PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4790 White Bear Pkwy
White Bear Lake, MN 55110
Phone (651) 426-3873

Practitioners & affiliated clinicians

Practitioners 1

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": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1417115189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4790 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103336",
            "telephone_number": "651-426-3873",
            "fax_number": "651-653-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4790 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103336",
            "telephone_number": "651-426-3873",
            "fax_number": "651-653-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON/AAMODT ORTHODONTICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-426-3873",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "D9558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; 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.