Active NPI
Brady Michael Andvik, D.D.S.
- Dentist
- Elk River, MN
National Provider Identifier
1831456789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D13082
- Practice address
- 303 Main St NW
Elk River, MN 55330-1531 - Phone
- (763) 441-9181
- NPI assigned
- Apr 17, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | D13082 | MN | Primary |
Addresses
Primary practice location
303 Main St NW
Elk River, MN 55330-1531
Mailing address
930 37TH Ave S
Moorhead, MN 56560-6130
Phone (218) 329-1972
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13082 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elk River Family Dentistry | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Elk River, MN
- NPI 1245303254
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337904000000",
"number": "1831456789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 37TH AVE S",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565606130",
"telephone_number": "218-329-1972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 MAIN ST NW",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301531",
"telephone_number": "763-441-9181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDVIK",
"first_name": "BRADY",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-17",
"last_updated": "2012-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D13082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.