Willmar Dental Clinic

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Legal business name

WILLMAR DENTAL CLINIC

Practice address

1604 1St St. S
Suite 140
Willmar, MN 56201-2276

Phone

(320) 231-5315

Fax

(320) 231-5303

NPI assigned

Jan 29, 2007

Organization subpart

No

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

Authorized official

Name

Lynn Glancey

Title

Chief Financial Officer

Phone

(651) 539-7200

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1811033061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 LABORE RD.",
            "address_2": "SUITE 104",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105186",
            "telephone_number": "651-539-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 1ST ST. S",
            "address_2": "SUITE 140",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562012276",
            "telephone_number": "320-231-5315",
            "fax_number": "320-231-5303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 TECHNOLOGY DR NE",
            "address_purpose": "LOCATION",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "56201",
            "country_code": "US",
            "telephone_number": "320-231-5100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILLMAR DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A",
        "authorized_official_last_name": "GLANCEY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "651-539-7200"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "243833000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Public Health Dentistry in Willmar, MN
• Providers in Willmar, MN by specialty
• Public Health Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; 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.