Eagle Lake Family Dentistry, PA

Primary specialty

DentistTaxonomy code 122300000X

License

D9088 Issued in MN

Legal business name

EAGLE LAKE FAMILY DENTISTRY, PA

Doing business as

St. James Family Dentistry

Practice address

504 2ND Ave S
Saint James, MN 56081-1737

Phone

(507) 375-4611

Fax

(507) 375-4989

NPI assigned

Aug 2, 2011

Last updated

Aug 2, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

EAGLE LAKE FAMILY DENTISTRY, PAAs reported in NPPES

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

Authorized official

Name

Dr. Sean Patrick Vostad, DDSNPI 1649340050

Title

Dentist

Phone

(507) 257-3800

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• St. James Family Dentistry Doing business as

Tax ID family

Eagle Lake Family Dentistry PA2 organizations share this tax ID, including this one

Part of

Eagle Lake Family Dentistry PA

Other organizations with this tax ID 1

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

• Eagle Lake Family Dentistry, P.a.

  • General Practice Dentistry
  • Eagle Lake, MN
  • NPI 1528138948
  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.

• Sean Patrick Vostad, BS, DDS

  • General Practice Dentistry
  • Saint James, MN
  • NPI 1649340050
  Authorized official Same address or phone

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312243200000",
    "number": "1689952038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 2ND AVE S",
            "address_2": "PO BOX 515",
            "city": "SAINT JAMES",
            "state": "MN",
            "postal_code": "560811737",
            "telephone_number": "507-375-4611",
            "fax_number": "507-375-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 2ND AVE S",
            "city": "SAINT JAMES",
            "state": "MN",
            "postal_code": "560811737",
            "telephone_number": "507-375-4611",
            "fax_number": "507-375-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE LAKE FAMILY DENTISTRY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE LAKE FAMILY DENTISTRY, PA",
        "enumeration_date": "2011-08-02",
        "last_updated": "2011-08-02",
        "status": "A",
        "authorized_official_last_name": "VOSTAD",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "507-257-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11770",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12980",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D9088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1245529650",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1528138948",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1649340050",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770653446",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. James Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angelica Maria De Acosta, CHW
• Paul Dorn, PTA
• Dr Steven Jeppson, Optometrist, PA (Eyecare Center of St James)
• Dr. T.a. Pinke, Inc
• DRS Moulton & Parsons MD
• Lindy C Eatwell, DO
• Darci Lee Eigenberg, R.T (R)
• Kyle Robert Elliott, NP
• Bridget Sue Forstrom, O.D.
• Norma L Garza

• Dentist in Saint James, MN
• Providers in Saint James, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; 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.