NPIMap

Organization Active NPI

Michael T. Pederson, DDS

  • General Practice Dentistry
  • Walker, MN
National Provider Identifier
1487675005
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MICHAEL T. PEDERSON, DDS
Practice address
108 Michigan Avenue West
Walker, MN 56484
Phone
(218) 547-1851
Fax
(218) 547-2261
NPI assigned
Jul 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Kathryn Denise Barker
Title
Office Manager
Phone
(218) 547-1851

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

108 Michigan Avenue West
Walker, MN 56484

Mailing address

PO Box 1389
Walker, MN 56484-1389
Phone (218) 547-1851

Other names 1

  • Steven E. Bilben, DDS Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487675005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1389",
            "city": "WALKER",
            "state": "MN",
            "postal_code": "564841389",
            "telephone_number": "218-547-1851",
            "fax_number": "218-547-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 MICHIGAN AVENUE WEST",
            "city": "WALKER",
            "state": "MN",
            "postal_code": "56484",
            "telephone_number": "218-547-1851",
            "fax_number": "218-547-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL T. PEDERSON, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BARKER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "218-547-1851",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Steven E. Bilben, DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walker, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.