Roger Martin Amundson, DDS, FAGD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1781 Issued in ND

Practice address

2600 Demers Ave
Grand Forks, ND 58201-4100

Phone

(701) 772-0171

NPI assigned

Nov 7, 2006

Last updated

Jul 13, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amundson Dental Associates

  • Dental Clinic/Center
  • Grand Forks, ND
  • NPI 1215465372
  NPD

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1437228095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014100",
            "telephone_number": "701-772-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014100",
            "telephone_number": "701-772-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMUNDSON",
        "first_name": "ROGER",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "DDS, FAGD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "1781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41067",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSC CORPORATION",
            "identifier": "901781",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Amundgaard-Pagnac, PMHNP-BC
• Amundson Dental Associates
• Anna Amundson
• Janet Amundson, MA
• Matthew Duane Amundson, MD
• Scott M Amundson, DDS
• Kristi Anderson Larson
• Megan Lynn Anderson Weisgram
• Amy Lynn Anderson, OT
• Beth Jean Anderson, APRN, CNP

• General Practice Dentistry in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• General Practice Dentistry in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.