Jessica L Miskavige, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2346 Issued in ND

Practice address

212 S 4TH St Ste 101
Grand Forks, ND 58201-4776

Phone

(701) 757-2100

NPI assigned

Jul 11, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Larimore, ND
  • NPI 1255317905
  NPD (past)
• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Grand Forks, ND
  • NPI 1689878324
  NPD (past)

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1871079079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S 4TH ST STE 200",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014781",
            "telephone_number": "701-757-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S 4TH ST STE 101",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014776",
            "telephone_number": "701-757-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISKAVIGE",
        "first_name": "JESSICA",
        "middle_name": "L",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-11",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ND",
            "license": "2346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kaye Mills, PMHNP
• Mind Path Mental Health PLLC
• Cassidy A Mindeman, PA
• Minnesota Optometric Eye Doctor, P.a.
• Miracle Hands Care
• Lindsey G Miskavige, CF-SLP
• Thomas Christopher Miskavige, MD
• Jennifer Leigh Modeen, LCSW
• Nathan Modeen, LCSW
• Susan Ann Moe Paulson

• Dentist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Dentist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.