Active NPI
John David Nydahl, D.D.S.
- Endodontics
- Saint Cloud, MN
National Provider Identifier
1508869371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D8204
- Practice address
- 1011 2ND St N
Ste 101
Saint Cloud, MN 56303-3237 - Phone
- (320) 253-0744
- Fax
- (320) 253-9930
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D8204 | MN | Primary |
Addresses
Primary practice location
1011 2ND St N
Ste 101
Saint Cloud, MN 56303-3237
Mailing address
1011 2ND St N
Ste 101
Saint Cloud, MN 56303-3237
Phone (320) 253-0744
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8204 | MN | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John D. Nydahl, DDS, P. a. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Saint Cloud, MN
- NPI 1174547855
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508869371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 2ND ST N",
"address_2": "STE 101",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563033237",
"telephone_number": "320-253-0744",
"fax_number": "320-253-9930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 2ND ST N",
"address_2": "STE 101",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563033237",
"telephone_number": "320-253-0744",
"fax_number": "320-253-9930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYDAHL",
"first_name": "JOHN",
"middle_name": "DAVID",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MN",
"license": "D8204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.