John Paul Iverson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11050 Issued in MN

Practice address

509 16TH Ave SW
Willmar, MN 56201-4118

Phone

(320) 235-7742

Fax

(320) 235-4045

NPI assigned

May 13, 2006

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Glacial Lakes Dental, PLLP

  • Dental Clinic/Center
  • Willmar, MN
  • NPI 1184923096
  NPD (past)
• Southwest Professional Inc

  • General Practice Dentistry
  • Willmar, MN
  • NPI 1861546855

  General Practice

  NPD (past)

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1508817586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 16TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014118",
            "telephone_number": "320-235-7742",
            "fax_number": "320-235-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 16TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014118",
            "telephone_number": "320-235-7742",
            "fax_number": "320-235-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fatuma Abdullahi Hussein
• Infinia at Willmar
• Faisal Ahmed Ismail, RN
• Hodo Ismail
• Ladan Ismail
• Taylor Elizabeth Iverson, DPT
• Linda A Jackson, DDS
• Jeanne Jacobs, LPCC, NCC
• Teresa Jaeger, LADC
• Shane Jahraus

• General Practice Dentistry in Willmar, MN
• Providers in Willmar, 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 13, 2026; 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.