Thief River Falls Family Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

D12920 Issued in MN

Legal business name

THIEF RIVER FALLS FAMILY DENTISTRY

Practice address

310 Red Lake Blvd
Thief River Falls, MN 56701-2133

Phone

(218) 681-2545

Fax

(218) 681-2560

NPI assigned

Apr 27, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Michael Dale Eickman, DDS

Title

President

Phone

(218) 681-2545

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335484800000",
    "number": "1811255870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 RED LAKE BLOULEVARD",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012133",
            "telephone_number": "218-681-2545",
            "fax_number": "218-681-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 RED LAKE BLVD",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012133",
            "telephone_number": "218-681-2545",
            "fax_number": "218-681-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIEF RIVER FALLS FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-27",
        "last_updated": "2012-04-27",
        "status": "A",
        "authorized_official_last_name": "EICKMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-681-2545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suresh Sreedharan, M.D.
• Terry Lee Storm, R.PH.
• Eiley Christina Sundby, M.S., CCC-SLP
• Chad Henry Tabatt, PT
• Irene V Tevlin, PMHNP-BC
• Thief River Falls Public Schools Isd564
• Thomas P. Dimich, DDS, PA
• Thompson Psychiatric Services LLC
• Max Thompson, PHARMD
• Vanessa R Thompson, OTR/L

• Dentist in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; 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.