Dipaul Dental, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13499 Issued in MN

Legal business name

DIPAUL DENTAL, PC

Doing business as

Aspen Dental

Practice address

2219 Paul Bunyan Dr NW Ste 6-7
Bemidji, MN 56601-6188

Phone

(218) 751-2659

Fax

(218) 751-1806

NPI assigned

Apr 7, 2015

Organization subpart

No

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

Authorized official

Name

Kim Van Camp

Title

Provider Enrollment Specialist

Phone

(315) 454-6000

Specialties & licenses 1

Addresses

Other names 1

• Aspen Dental Doing business as

Locations

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1508252578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000",
            "fax_number": "866-273-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 PAUL BUNYAN DR NW STE 6-7",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566016188",
            "telephone_number": "218-751-2659",
            "fax_number": "218-751-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIPAUL DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "VAN CAMP",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "13499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lindamulage Supun Dinithi Chandr Devaadithiya-Appuhamy, DNP, PMHNP-BC, CNP
• Jessica A. Dewey, LADC
• William G Dicks, MD
• Betsy Dickson
• Janice Marie Dickson, NP
• Deborah J Diver Leith, LADC
• Dixon Chiropractic P.a.
• Jason Wade Dixon, DC
• Nicole Rae Dixon, B.A.
• Jennifer Lynn Djonne, MA, LICSW

• General Practice Dentistry in Bemidji, MN
• Providers in Bemidji, 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 Apr 7, 2015; 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.