Active NPI
Prairie Lakes Family Dentistry
- General Practice Dentistry
- Tracy, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- PRAIRIE LAKES FAMILY DENTISTRY
- Doing business as
- Prairie Lakes Family Dentistry
- Practice address
- 212 3Rd St
Tracy, MN 56175-1214 - Phone
- (507) 212-0002
- Fax
- (507) 212-0020
- NPI assigned
- Dec 21, 2023
- Last updated
- Dec 21, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jon Heezen, DDS
- Title
- Owner/Dentist
- Phone
- (507) 212-0002
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) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | NU | Primary |
Addresses
Primary practice location
212 3Rd St
Tracy, MN 56175-1214
Mailing address
PO Box 1174
Tracy, MN 56175-0174
Phone (507) 212-0002
Other names 1
- Prairie Lakes Family Dentistry
National Provider Directory
National Provider Directory- Tax ID family
- Prairie Lakes Family Dentistry
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Dentistry
- Tracy, MN
- NPI 1821946807
Locations
212 3rd St
Tracy, MN 56175
Phone (507) 212-0002
Practitioners & affiliated clinicians
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.
-
- Student in an Organized Health Care Education/Training Program
- Tracy, MN
- NPI 1013276252
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703116800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1703116800000",
"number": "1780453589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1174",
"city": "TRACY",
"state": "MN",
"postal_code": "561750174",
"telephone_number": "507-212-0002",
"fax_number": "507-212-0020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 3RD ST",
"city": "TRACY",
"state": "MN",
"postal_code": "561751214",
"telephone_number": "507-212-0002",
"fax_number": "507-212-0020"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRAIRIE LAKES FAMILY DENTISTRY",
"organizational_subpart": "NO",
"enumeration_date": "2023-12-21",
"last_updated": "2023-12-21",
"certification_date": "2023-12-21",
"status": "A",
"authorized_official_last_name": "HEEZEN",
"authorized_official_first_name": "JON",
"authorized_official_title_or_position": "OWNER/DENTIST",
"authorized_official_telephone_number": "507-212-0002",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Prairie Lakes Family Dentistry",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tracy, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.