NPIMap

Individual provider Active NPI

Laura Anthonia Undraitis, DDS

  • General Practice Dentistry
  • Kalispell, MT
National Provider Identifier
1750418588
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1979 Issued in MT
Practice address
195 Commons Loop a- Montana Dental Designs
Kalispell, MT 59901-1912
Phone
(406) 755-5280
Fax
(406) 752-7679
NPI assigned
Feb 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X 1979 MT
General Practice Dentistry 1223G0001X 1979 MT Primary

Addresses

Primary practice location

195 Commons Loop a- Montana Dental Designs
Kalispell, MT 59901-1912

Mailing address

195 Commons Loop a- Montana Dental Designs
Kalispell, MT 59901-1912
Phone (406) 755-5280

Other names 1

  • Laura Anthonia Raddatz Former name

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

LicenseStateTypeSpecialty
1979MTMDPublic Health Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ronald B Potthoff DDS General Practice CurrentSince Aug 23, 2020 Accepting new patients
Tim Mathews DDS PLLC General Practice CurrentSince Sep 12, 2021 Accepting new patients
Alpenglow Dental, PC Past Accepting new patients

Locations

195 Commons Loop
Ste A
Kalispell, MT 59901
Phone (406) 755-5280

Organizations & group practices 3

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": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1750418588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 COMMONS LOOP A- MONTANA DENTAL DESIGNS",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599011912",
            "telephone_number": "406-755-5280",
            "fax_number": "406-752-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 COMMONS LOOP A- MONTANA DENTAL DESIGNS",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599011912",
            "telephone_number": "406-755-5280",
            "fax_number": "406-752-7679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDRAITIS",
        "first_name": "LAURA",
        "middle_name": "ANTHONIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2023-12-11",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "MT",
            "license": "1979",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "1979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "RADDATZ",
            "middle_name": "ANTHONIA",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kalispell, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; 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.