NPIMap

Organization Active NPI

Mark T. Sherman DDS PA

  • Dental Clinic/Center
  • Pequot Lakes, MN
National Provider Identifier
1770195158
Registry record updated Aug 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MARK T. SHERMAN DDS PA
Practice address
31011 Rasmussen Rd
Pequot Lakes, MN 56472-1227
Phone
(218) 568-8295
NPI assigned
Aug 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2020

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

Authorized official

Name
Mark T Sherman, DDSNPI 1649360470
Title
Owner
Phone
(218) 568-8295

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

31011 Rasmussen Rd
Pequot Lakes, MN 56472-1227

Mailing address

PO Box 128
Pequot Lakes, MN 56472-0128
Phone (218) 568-8295

Other identifiers 1

IdentifierTypeStateIssuer
D11015OtherMNBOARD LICENSE

Other names 1

  • Pequot Lakes Dental Center Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@pequotlakesdentalcenter.com Other

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1770195158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564720128",
            "telephone_number": "218-568-8295",
            "fax_number": "218-568-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31011 RASMUSSEN RD",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564721227",
            "telephone_number": "218-568-8295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK T. SHERMAN DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "SHERMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-568-8295",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD LICENSE",
            "identifier": "D11015",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@pequotlakesdentalcenter.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Pequot Lakes",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Pequot Lakes",
            "address_1": "31011 Rasmussen Rd",
            "city": "Pequot Lakes",
            "state": "MN",
            "country_code": "US",
            "postal_code": "564721227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pequot Lakes Dental Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Pequot Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.

Verify at the official NPI Registry.