NPIMap

Organization Active NPI

Grand Dental Center

  • Dentist
  • Grand Rapids, MN
National Provider Identifier
1457644049
Registry record updated May 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11285 Issued in MN
Legal business name
GRAND DENTAL CENTER
Practice address
1604 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone
(218) 326-0339
Fax
(218) 999-5443
NPI assigned
May 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2011

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

Authorized official

Name
Dr. Lisa M Johnson, DDSNPI 1730242215
Title
Dentist
Phone
(218) 326-0339

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D11285 MN Primary

Addresses

Primary practice location

1604 Golf Course Rd
Grand Rapids, MN 55744-8648

Mailing address

1604 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-0339

National Provider Directory

National Provider Directory

Locations

1604 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-0339

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1457644049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-326-0339",
            "fax_number": "218-999-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-326-0339",
            "fax_number": "218-999-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-16",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "218-326-0339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; 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.