Active NPI
Jacob John Dale Held, DDS
- Dentist
- Pine River, MN
National Provider Identifier
1629694963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14375
- Practice address
- 203 Park Ave
Pine River, MN 56474 - Phone
- (218) 587-4437
- Fax
- (218) 587-4479
- NPI assigned
- Jun 23, 2020
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D14375 | MN | Primary |
Addresses
Primary practice location
203 Park Ave
Pine River, MN 56474
Mailing address
17751 96TH Ave N
Maple Grove, MN 55311-1272
Phone (320) 828-0302
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 |
|---|---|---|---|
| D14375 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1629694963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17751 96TH AVE N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553111272",
"telephone_number": "320-828-0302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 PARK AVE",
"city": "PINE RIVER",
"state": "MN",
"postal_code": "56474",
"telephone_number": "218-587-4437",
"fax_number": "218-587-4479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HELD",
"first_name": "JACOB",
"middle_name": "JOHN DALE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-23",
"last_updated": "2024-08-05",
"certification_date": "2020-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.