NPIMap

Organization Active NPI

Minnesota State Colleges and Universities

  • General Practice Dentistry
  • Brainerd, MN
National Provider Identifier
1801065958
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MINNESOTA STATE COLLEGES AND UNIVERSITIES
Practice address
501 W College Dr
Brainerd, MN 56401-3904
Phone
(218) 855-8000
NPI assigned
Feb 22, 2008
Organization subpart
Yes
Parent organization
MINNESOTA STATE COLLEGES AND UNIVERSITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Larry Lundblad
Title
President
Phone
(218) 855-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X MN Primary

Addresses

Primary practice location

501 W College Dr
Brainerd, MN 56401-3904

Mailing address

501 W College Dr
Brainerd, MN 56401-3904
Phone (218) 855-8000

Other names 1

  • Central Lakes College Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Cloud State University27 organizations share this tax ID, including this one
Part of
St Cloud State University

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

501 W College Dr
Brainerd, MN 56401
Phone (218) 855-8000

NPI Registry JSON

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

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1801065958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W COLLEGE DR",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013904",
            "telephone_number": "218-855-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W COLLEGE DR",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013904",
            "telephone_number": "218-855-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA STATE COLLEGES AND UNIVERSITIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNESOTA STATE COLLEGES AND UNIVERSITIES",
        "enumeration_date": "2008-02-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LUNDBLAD",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-855-8000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Lakes College",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.