Northcreek Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

NORTHCREEK DENTAL PC

Doing business as

Lidgerwood Dental

Practice address

19 Wiley Ave
Lidgewood, ND 58053

Phone

(701) 538-4583

Fax

(701) 538-4560

NPI assigned

Jan 5, 2017

Last updated

Jan 5, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark Schaffer, DDS

Title

Ower/Dentish

Phone

(701) 242-7140

Specialties & licenses 1

Addresses

Other names 1

• Lidgerwood Dental Doing business as

Tax ID family

Hankinson Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Northcreek Dental PC

  • Endodontics
  • Fargo, ND
  • NPI 1467524496
  NPD tax ID
• Northcreek Dental, PC

  dba Hankinson Dental

  • Dental Clinic/Center
  • Hankinson, ND
  • NPI 1902203854
  NPD tax ID

Practitioners 1

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.

• James D Marotzke, DDS

  • General Practice Dentistry
  • Lidgerwood, ND
  • NPI 1376692756
  NPD (past)

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483574400000",
    "number": "1669917308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17060 HWY 46",
            "city": "HORACE",
            "state": "ND",
            "postal_code": "58047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 WILEY AVE",
            "city": "LIDGEWOOD",
            "state": "ND",
            "postal_code": "58053",
            "telephone_number": "701-538-4583",
            "fax_number": "701-538-4560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHCREEK DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-05",
        "last_updated": "2017-01-05",
        "status": "A",
        "authorized_official_last_name": "SCHAFFER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWER/DENTISH",
        "authorized_official_telephone_number": "701-242-7140",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lidgerwood Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.