NPIMap

Organization Active NPI

Lewiston Dental Care

  • General Practice Dentistry
  • Lewiston, MN
National Provider Identifier
1801443049
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LEWISTON DENTAL CARE
Practice address
560 Debra Dr
Lewiston, MN 55952
Phone
(507) 523-1071
Fax
(507) 523-1078
NPI assigned
Aug 22, 2019
Last updated
Aug 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Authorized official

Name
Dr. Bradley John Bullard, DDS
Title
Dentist/Owner
Phone
(507) 523-1071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

560 Debra Dr
Lewiston, MN 55952

Mailing address

560 Debra Dr
PO Box 697
Lewiston, MN 55952
Phone (507) 523-1071

National Provider Directory

National Provider Directory
Tax ID family
Lewiston Dental Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the 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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566432000000",
    "number": "1801443049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 DEBRA DR",
            "address_2": "PO BOX 697",
            "city": "LEWISTON",
            "state": "MN",
            "postal_code": "55952",
            "telephone_number": "507-523-1071",
            "fax_number": "507-523-1078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 DEBRA DR",
            "city": "LEWISTON",
            "state": "MN",
            "postal_code": "55952",
            "telephone_number": "507-523-1071",
            "fax_number": "507-523-1078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWISTON DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-22",
        "last_updated": "2019-08-22",
        "status": "A",
        "authorized_official_last_name": "BULLARD",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "507-523-1071",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; 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.