Active NPI
Jennifer Jo Laberge, DDS
- Dentist
- Scandia, MN
National Provider Identifier
1669517579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 011997
- Practice address
- 21080 Olinda Trail N
Scandia, MN 55073 - Phone
- (615) 433-2655
- NPI assigned
- Feb 20, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 | 011997 | MN | Primary |
Addresses
Primary practice location
21080 Olinda Trail N
Scandia, MN 55073
Mailing address
21080 Olinda Trail N
Scandia, MN 55073
Phone (615) 433-2655
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 |
|---|---|---|---|
| 011997 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669517579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21080 OLINDA TRAIL N",
"city": "SCANDIA",
"state": "MN",
"postal_code": "55073",
"telephone_number": "615-433-2655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21080 OLINDA TRAIL N",
"city": "SCANDIA",
"state": "MN",
"postal_code": "55073",
"telephone_number": "615-433-2655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LABERGE",
"first_name": "JENNIFER",
"middle_name": "JO",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "011997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scandia, MN
- Heidi Goelz
- Haven Chemical Health Systems, LLC (Rebecca Residence Scandia)
- Heart to Heart Home Care LLC (Hearts Of Hope Home Care)
- Kendrick Chiropractic Clinic LTD.
- Leland James Kendrick, DC
- Ladd Memorial Hospital
- Ladd Memorial Hospital (Osceola Medical Center Scandia Clinic)
- Laura Fawn Libby
- Loon Holistic Health
- Stephanie Rachel Martell, D.C.
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.