Joshua Luther Agrimson, DDS – Dentist

Key facts

NPI: 1508937830
Entity type: Individual (NPI type 1)
Primary specialty: Dentist 122300000X
License: 5886 (WI)
Practice address: 650 South Main St
River Falls, WI 54022
Phone: (715) 425-6732
Fax: (715) 425-0101
NPI assigned: Nov 10, 2006
Sex: Male
Sole proprietor: No

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.

River Falls Dental Assoc LTD General Practice Dentistry · River Falls, WI · NPI 1487873527

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Opted out of Medicare: Yes, effective May 10, 2016 through May 10, 2028

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
5886	WI	MD	Dentist

Practice roles

Organization	Specialty	Status	New patients
River Falls Dental Assoc LTD		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	5886	WI	Yes

Addresses

Primary practice location

650 South Main St
River Falls, WI 54022

Mailing address

650 South Main St
River Falls, WI 54022
Phone (715) 425-6732

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508937830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 SOUTH MAIN ST",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "54022",
            "telephone_number": "715-425-6732",
            "fax_number": "715-425-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 SOUTH MAIN ST",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "54022",
            "telephone_number": "715-425-6732",
            "fax_number": "715-425-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGRIMSON",
        "first_name": "JOSHUA",
        "middle_name": "LUTHER",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in River Falls, WI

All providers in River Falls, WI · Dentist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Opt Out Affidavits (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.