NPIMap

Organization Active NPI

Family Dentistry of Moorhead, LTD.

  • General Practice Dentistry
  • Moorhead, MN
National Provider Identifier
1841258837
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9145 Issued in MN
Legal business name
FAMILY DENTISTRY OF MOORHEAD, LTD.
Practice address
1616 30TH Ave S
Moorhead, MN 56560-5152
Phone
(218) 233-4267
NPI assigned
May 2, 2006
Last updated
Jun 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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

Authorized official

Name
Mr. Christopher Mark Mathison, DDSNPI 1366494254
Title
Owner/DDS
Phone
(218) 233-4267

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 9145 MN Primary

Addresses

Primary practice location

1616 30TH Ave S
Moorhead, MN 56560-5152

Mailing address

1616 30TH Ave S
Moorhead, MN 56560-5152
Phone (218) 233-4267

National Provider Directory

National Provider Directory

Locations

1616 30th Ave S
Moorhead, MN 56560
Phone (218) 223-4267

Practitioners & affiliated clinicians

Practitioners 1

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": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1841258837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605152",
            "telephone_number": "218-233-4267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605152",
            "telephone_number": "218-233-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTISTRY OF MOORHEAD, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "MATHISON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER/DDS",
        "authorized_official_telephone_number": "218-233-4267",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.