NPIMap

Organization Active NPI

Deer River Dental Clinic

  • Endodontics
  • Deer River, MN
National Provider Identifier
1417464157
Registry record updated Jan 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
D9499 Issued in MN
Legal business name
DEER RIVER DENTAL CLINIC
Practice address
111 Main Street E
Deer River, MN 56636
Phone
(218) 246-8200
NPI assigned
Jan 3, 2018
Last updated
Jan 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2018

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

Authorized official

Name
Jeffrey Lee Ccarter, DDS
Title
Dentist/Owner
Phone
(218) 246-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X D9499 MN Primary

Addresses

Primary practice location

111 Main Street E
Deer River, MN 56636

Mailing address

PO Box 40
Deer River, MN 56636-0040
Phone (218) 246-8200

National Provider Directory

National Provider Directory

Locations

111 Main Ave E
Deer River, MN 56636
Phone (218) 246-8200

Practitioners & affiliated clinicians

Practitioners 2

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": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514937600000",
    "number": "1417464157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "DEER RIVER",
            "state": "MN",
            "postal_code": "566360040",
            "telephone_number": "218-246-8200",
            "fax_number": "218-246-8982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MAIN STREET E",
            "city": "DEER RIVER",
            "state": "MN",
            "postal_code": "56636",
            "telephone_number": "218-246-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER RIVER DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-01-03",
        "status": "A",
        "authorized_official_last_name": "CCARTER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "218-246-8200",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "D9499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer River, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; 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.