Active NPI
Thomas Luke Bashaw, D.D.S.
- Dentist
- Elk River, MN
National Provider Identifier
1922065416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D09824
- Practice address
- 710 Dodge Ave NW
Suite B
Elk River, MN 55330-2019 - Phone
- (763) 441-3922
- NPI assigned
- Apr 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D09824 | MN | Primary |
Addresses
Primary practice location
710 Dodge Ave NW
Suite B
Elk River, MN 55330-2019
Mailing address
710 Dodge Ave NW
Suite B
Elk River, MN 55330-2019
Phone (763) 441-3922
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D09824 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408406400000",
"number": "1922065416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 DODGE AVE NW",
"address_2": "SUITE B",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553302019",
"telephone_number": "763-441-3922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 DODGE AVE NW",
"address_2": "SUITE B",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553302019",
"telephone_number": "763-441-3922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASHAW",
"first_name": "THOMAS",
"middle_name": "LUKE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2014-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D09824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.