NPIMap

Organization Active NPI

Greenhaven Family Dental

  • General Practice Dentistry
  • Baxter, MN
National Provider Identifier
1508125584
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D10518 Issued in MN
Legal business name
GREENHAVEN FAMILY DENTAL
Practice address
13495 Elder Dr
Suite 100
Baxter, MN 56425-8763
Phone
(218) 454-0523
Fax
(218) 454-0524
NPI assigned
May 10, 2012
Last updated
May 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Authorized official

Name
Clinton L Roberts, DDS
Title
Owner
Phone
(218) 454-0523

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D10518 MN Primary

Addresses

Primary practice location

13495 Elder Dr
Suite 100
Baxter, MN 56425-8763

Mailing address

13495 Elder Dr
Suite 100
Baxter, MN 56425-8763
Phone (218) 454-0523

National Provider Directory

National Provider Directory
Tax ID family
Greenhaven Family Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13495 Elder Dr
Ste 100
Baxter, MN 56425
Phone (218) 454-0523

NPI Registry JSON

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

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1508125584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13495 ELDER DR",
            "address_2": "SUITE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258763",
            "telephone_number": "218-454-0523",
            "fax_number": "218-454-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13495 ELDER DR",
            "address_2": "SUITE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258763",
            "telephone_number": "218-454-0523",
            "fax_number": "218-454-0524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENHAVEN FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-454-0523",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.