Jacob L. Barthold DDS, PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D13073 Issued in MN

Legal business name

JACOB L. BARTHOLD DDS, PA

Practice address

69 Lake St N Ste 100
Forest Lake, MN 55025-2527

Phone

(763) 746-6567

NPI assigned

Jul 26, 2017

Last updated

Jul 26, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jacob Lee Barthold, DDSNPI 1457613028

Title

President

Phone

(763) 746-6567

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Jacob Lee Barthold, D.D.S.

  • General Practice Dentistry
  • Redwood Falls, MN
  • NPI 1457613028
  Authorized official Same address or phone

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501027200000",
    "number": "1851815310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E BRIDGE ST",
            "city": "REDWOOD FALLS",
            "state": "MN",
            "postal_code": "562831621",
            "telephone_number": "763-746-6567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 LAKE ST N STE 100",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252527",
            "telephone_number": "763-746-6567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB L. BARTHOLD DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-26",
        "last_updated": "2017-07-26",
        "status": "A",
        "authorized_official_last_name": "BARTHOLD",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-746-6567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D13073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457613028",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Heather Marie Jeffrey, MA, LPCC, LADC

• Dental Clinic/Center in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2017; 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.