Active NPI
Ethan Jon Brekke, DDS
- General Practice Dentistry
- Duluth, MN
National Provider Identifier
1689282469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D14446
- Practice address
- 1432 London Rd
Duluth, MN 55805-2425 - Phone
- (218) 728-5095
- NPI assigned
- Jul 17, 2020
- Last updated
- Jul 17, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D14446 | MN | Primary |
Addresses
Primary practice location
1432 London Rd
Duluth, MN 55805-2425
Mailing address
220 W 7TH St
Duluth, MN 55806-2512
Phone (218) 234-8823
Other practice location 1
324 W Superior St Ste 930
Duluth, MN 55802-1716
Phone (218) 727-5041
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | ethan.j.brekke@gmail.com |
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 |
|---|---|---|---|
| D14446 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Miller Hill Dental PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594944000000",
"number": "1689282469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 W 7TH ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558062512",
"telephone_number": "218-234-8823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1432 LONDON RD",
"city": "DULUTH",
"state": "MN",
"postal_code": "558052425",
"telephone_number": "218-728-5095"
}
],
"practiceLocations": [
{
"address_1": "324 W Superior St Ste 930",
"address_purpose": "LOCATION",
"city": "Duluth",
"state": "MN",
"postal_code": "558021716",
"country_code": "US",
"telephone_number": "218-727-5041",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BREKKE",
"first_name": "ETHAN",
"middle_name": "JON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-17",
"last_updated": "2020-07-17",
"certification_date": "2020-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D14446",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "ethan.j.brekke@gmail.com",
"affiliation": "N",
"address_1": "1432 London Rd",
"city": "Duluth",
"state": "MN",
"country_code": "US",
"postal_code": "558052425",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.