Justin James Gangestad, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13729 Issued in MN

Practice address

13442 Elmwood Dr
Baxter, MN 56425-8400

Phone

(218) 829-4207

NPI assigned

Jul 8, 2016

Last updated

Jul 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Baxter Dental

  • Dental Clinic/Center
  • Baxter, MN
  • NPI 1245840487
  NPD (past)
• Baxter Dental PLLC

  • Dental Clinic/Center
  • Baxter, MN
  • NPI 1790415842
  NPD (past)

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

{
    "created_epoch": "1467936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467936000000",
    "number": "1477905990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4940 CIRCLE PINES RD",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564259501",
            "telephone_number": "218-851-8108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13442 ELMWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258400",
            "telephone_number": "218-829-4207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGESTAD",
        "first_name": "JUSTIN",
        "middle_name": "JAMES",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-08",
        "last_updated": "2016-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maren Elizabeth Friemann
• Bryana Fuentes
• James A Furda, M.D.
• Kayla Ann Fussy, MD
• Kaley Anne Gadbois, PA-C
• Tanya Ruby Garson
• Rebecca Lynn Gatton, MS, LPC
• Steven Ray Gatton, MS, LPCC
• Tori Lynn Geisler
• Genoa Healthcare LLC

• General Practice Dentistry in Baxter, MN
• Providers in Baxter, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; 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.