Jonathan Bultema, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2046 Issued in ND

Practice address

594 Main St N
Horace, ND 58047-4640

Phone

(701) 552-6001

Fax

(701) 781-8056

NPI assigned

Feb 5, 2010

Last updated

Feb 7, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maple Family Dental P.C.

  • Dental Clinic/Center
  • Horace, ND
  • NPI 1487105276
  NPD (past) Authorized official

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

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1669704300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "594 MAIN ST N",
            "city": "HORACE",
            "state": "ND",
            "postal_code": "580474640",
            "telephone_number": "701-552-6001",
            "fax_number": "701-781-8056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "594 MAIN ST N",
            "city": "HORACE",
            "state": "ND",
            "postal_code": "580474640",
            "telephone_number": "701-552-6001",
            "fax_number": "701-781-8056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULTEMA",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-05",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "2046",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SD",
            "license": "D1036",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "13339",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1451030",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Horace, ND
• Providers in Horace, ND by specialty
• General Practice Dentistry in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; 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.