NPIMap

Individual provider Active NPI

Whitney Christine Hustad Davidson, DDS

  • General Practice Dentistry
  • Duluth, MN
National Provider Identifier
1720165905
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12242 Issued in MN
Practice address
906 Woodland Ave
Duluth, MN 55812-1113
Phone
(218) 606-1040
Fax
(218) 606-1060
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12242 MN Primary

Addresses

Primary practice location

906 Woodland Ave
Duluth, MN 55812-1113

Mailing address

906 Woodland Ave
Duluth, MN 55812-1113
Phone (218) 606-1040

Other identifiers 5

IdentifierTypeStateIssuer
904481047559OtherMNPREFERRED ONE
276999900MedicaidMN
97G02HUOtherMNBCBSMN
1858670OtherMNUNITED CONCORDIA
HP65362OtherMNHEALTH PARTNERS

Other names 1

  • Dr. Whitney Christine Hustad Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jan 30, 2017 through Jan 30, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspring Dental Health Current Accepting new patients
Bluestone Dental PLLC General Practice Past Accepting new patients
PDG, PA Past Accepting new patients
Lake Superior Dental Associates General Practice PastSince Feb 2, 2021 Accepting new patients
Sla Dental PLLC General Practice Past Accepting new patients

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1720165905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121113",
            "telephone_number": "218-606-1040",
            "fax_number": "218-606-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121113",
            "telephone_number": "218-606-1040",
            "fax_number": "218-606-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSTAD DAVIDSON",
        "first_name": "WHITNEY",
        "middle_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "12242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "904481047559",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276999900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMN",
            "identifier": "97G02HU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1858670",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP65362",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WHITNEY",
            "last_name": "HUSTAD",
            "middle_name": "CHRISTINE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.