NPIMap

Organization Active NPI

Great River Dentistry of Bemidji, P.a.

  • General Practice Dentistry
  • Bemidji, MN
National Provider Identifier
1821260654
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GREAT RIVER DENTISTRY OF BEMIDJI, P.A.
Practice address
3622 Moberg Dr NW
Bemidji, MN 56601-5644
Phone
(218) 751-4216
Fax
(218) 444-6057
NPI assigned
Apr 1, 2008
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Douglas R Williams, DDSNPI 1164585642
Title
Owner
Phone
(218) 751-4216

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

3622 Moberg Dr NW
Bemidji, MN 56601-5644

Mailing address

PO Box 1005
Bemidji, MN 56619-1005
Phone (218) 751-4216

Other identifiers 1

IdentifierTypeStateIssuer
172820200MedicaidMN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1821260654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1005",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566191005",
            "telephone_number": "218-751-4216",
            "fax_number": "218-444-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3622 MOBERG DR NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015644",
            "telephone_number": "218-751-4216",
            "fax_number": "218-444-6057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER DENTISTRY OF BEMIDJI, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-751-4216",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172820200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bemidji, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.