Brekke Lee Johnsrud, DDS, MPH

Primary specialty

DentistTaxonomy code 122300000X

License

D14080 Issued in MN

Practice address

2020 1St Avenue
Hibbing, MN 55746

Phone

(218) 263-8951

Fax

(218) 263-8629

NPI assigned

Jul 4, 2018

Last updated

Nov 19, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Brekke Lee Hudelson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• David Gunelson DDS

  • General Practice Dentistry
  • Hibbing, MN
  • NPI 1982908315
  NPD (past)
• North Star Dental Care, P.C.

  • General Practice Dentistry
  • Hibbing, MN
  • NPI 1528455656
  NPD (past)

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

{
    "created_epoch": "1530662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574121600000",
    "number": "1922594753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 1ST AVENUE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "55746",
            "telephone_number": "218-263-8951",
            "fax_number": "218-263-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 1ST AVENUE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "55746",
            "telephone_number": "218-263-8951",
            "fax_number": "218-263-8629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSRUD",
        "first_name": "BREKKE",
        "middle_name": "LEE",
        "credential": "DDS, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-04",
        "last_updated": "2019-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14080",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14080",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREKKE",
            "last_name": "HUDELSON",
            "middle_name": "LEE",
            "credential": "DDS MPH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dana Ruthe Johnson
• Kimberly Louise Johnson, R.D.L.D.,CDE
• Mark Johnson
• Meredith Q Johnson, RD/LD
• Richard A. Johnson, DDS
• Ashley C Joki, ADT
• Elizabeth Jones, M.D.
• Molly Elizabeth Jones, CMT
• Marmie Pauline Jotter, LICSW
• Hannah Kaim

• Dentist in Hibbing, MN
• Providers in Hibbing, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; 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.