Warroad Family Dentistry, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9514 Issued in MN

Legal business name

WARROAD FAMILY DENTISTRY, LTD

Practice address

307 South State Ave
Warroad, MN 56763-0490

Phone

(218) 386-1048

Fax

(218) 386-1049

NPI assigned

Oct 21, 2005

Organization subpart

No

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

Authorized official

Name

Kathy Ann Thiele

Title

Corporate Secretary

Phone

(218) 386-1048

Specialties & licenses 1

Addresses

Other names 1

• Lake Family Dental Doing business as

Locations

Practitioners 2

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

• Mark Benjamin Thiele, D.D.S.

  • Dentist
  • Warroad, MN
  • NPI 1073994653
  NPD (past)
• Michael Ernest Thiele, DDS

  • Dentist
  • Warroad, MN
  • NPI 1225184450
  NPD (past)

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497745400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "WARROAD",
            "state": "MN",
            "postal_code": "567630490",
            "telephone_number": "218-386-1048",
            "fax_number": "218-386-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 SOUTH STATE AVE",
            "city": "WARROAD",
            "state": "MN",
            "postal_code": "567630490",
            "telephone_number": "218-386-1048",
            "fax_number": "218-386-1049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARROAD FAMILY DENTISTRY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THIELE",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "218-386-1048"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Up North Physical Therapy
• Up North Physical Therapy, LLC
• David Alan Verworn, DC
• Warroad Care Center, Inc.
• Warroad Chiropractic Clinic, P.a.
• Warroad Heritage Inc
• Warroad School District

• All providers in Warroad, MN
• General Practice Dentistry in Minnesota

• 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.