NPIMap

Organization Active NPI

Wadena Family Dental, P. a.

  • General Practice Dentistry
  • Wadena, MN
National Provider Identifier
1881864049
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D12083 Issued in MN
Legal business name
WADENA FAMILY DENTAL, P. A.
Practice address
122 Colfax Ave SW
Wadena, MN 56482-1470
Phone
(218) 631-4525
Fax
(218) 631-3998
NPI assigned
Mar 4, 2008
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Authorized official

Name
Dr. William Kim Larson, DDSNPI 1164519625
Title
Dentist
Phone
(218) 631-4525

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 D12083 MN Primary

Addresses

Primary practice location

122 Colfax Ave SW
Wadena, MN 56482-1470

Mailing address

122 Colfax Ave SW
Wadena, MN 56482-1470
Phone (218) 631-4525

National Provider Directory

National Provider Directory

Locations

122 Colfax Ave SW
Wadena, MN 56482
Phone (218) 631-4525

Practitioners & affiliated clinicians

Practitioners 4

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": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1881864049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 COLFAX AVE SW",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821470",
            "telephone_number": "218-631-4525",
            "fax_number": "218-631-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 COLFAX AVE SW",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821470",
            "telephone_number": "218-631-4525",
            "fax_number": "218-631-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADENA FAMILY DENTAL, P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "218-631-4525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wadena, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; 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.