NPIMap

Organization Active NPI

Souris Valley Dental Group

  • General Practice Dentistry
  • Minot, ND
National Provider Identifier
1861497430
Registry record updated Jun 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1573 Issued in ND
Legal business name
SOURIS VALLEY DENTAL GROUP
Practice address
1300 37TH Ave SW
Minot, ND 58701-7240
Phone
(701) 852-5595
Fax
(701) 852-2669
NPI assigned
Jun 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2015

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

Authorized official

Name
Dr. Mark A Hildahl, DDSNPI 1265645766
Title
Owner
Phone
(701) 852-5595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 1573 ND Primary

Addresses

Primary practice location

1300 37TH Ave SW
Minot, ND 58701-7240

Mailing address

1300 37TH Ave SW
Minot, ND 58701-7240
Phone (701) 852-5595

Other identifiers 2

IdentifierTypeStateIssuer
41311MedicaidND
000980706OtherNDUNITED CONCORDIA

National Provider Directory

National Provider Directory

Locations

1300 37th Ave SW
Minot, ND 58701
Phone (701) 852-3013

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1861497430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 37TH AVE SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587017240",
            "telephone_number": "701-852-5595",
            "fax_number": "701-852-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 37TH AVE SW",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587017240",
            "telephone_number": "701-852-5595",
            "fax_number": "701-852-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURIS VALLEY DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "HILDAHL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-852-5595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "1573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41311",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "000980706",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; 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.