NPIMap

Organization Active NPI

Ottertail Dental

  • General Practice Dentistry
  • Fergus Falls, MN
National Provider Identifier
1528673365
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OTTERTAIL DENTAL
Doing business as
Otter Tail Dental
Practice address
1409 College Way
Fergus Falls, MN 56537-1055
Phone
(218) 739-3245
Fax
(218) 739-5626
NPI assigned
Sep 9, 2020
Last updated
Sep 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Authorized official

Name
Ms. Sonja Ann Johnson
Title
Business Manager
Phone
(218) 739-3245

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1409 College Way
Fergus Falls, MN 56537-1055

Mailing address

1409 College Way
Fergus Falls, MN 56537-1055
Phone (218) 739-3245

Other names 1

  • Otter Tail Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1409 College Way
Fergus Falls, MN 56537
Phone (218) 739-3245

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1528673365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 COLLEGE WAY",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371055",
            "telephone_number": "218-739-3245",
            "fax_number": "218-739-5626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 COLLEGE WAY",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371055",
            "telephone_number": "218-739-3245",
            "fax_number": "218-739-5626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERTAIL DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SONJA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "218-739-3245",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Otter Tail Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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.