Rice Lake Dental, P.a.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

RICE LAKE DENTAL, P.A.

Practice address

13998 Maple Knoll Way Ste 100
Maple Grove, MN 55369-7004

Phone

(763) 420-5599

Fax

(763) 416-4771

NPI assigned

Oct 4, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Darrel Howard Johnsrud, DDSNPI 1639244650

Title

President

Phone

(612) 385-6718

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darrel Howard Johnsrud, D.D.S.

  • General Practice Dentistry
  • Maple Grove, MN
  • NPI 1639244650
  NPD Authorized official

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1760107502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13998 MAPLE KNOLL WAY STE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697004",
            "telephone_number": "763-420-5599",
            "fax_number": "763-416-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13998 MAPLE KNOLL WAY STE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697004",
            "telephone_number": "763-420-5599",
            "fax_number": "763-416-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICE LAKE DENTAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSRUD",
        "authorized_official_first_name": "DARREL",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-385-6718",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kacey Retterath, LPN
• Nguyen Reuvers
• Carrie M Reynoso, RD, LD
• Anita L. Richardson
• Brent Richter, L.P.C.
• Nathaniel James Richter, DPT
• Jennifer Mertz Riegel, PHARM.D
• Nicole Rieks, LAC.

• Dental Clinic/Center in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; 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.