NPIMap

Organization Active NPI

Northland Endodontics PA

  • Endodontics
  • Blaine, MN
National Provider Identifier
1932200037
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
D10585 Issued in MN
Legal business name
NORTHLAND ENDODONTICS PA
Practice address
11800 Aberdeen St NE
Suite 140
Blaine, MN 55449-4808
Phone
(763) 772-0330
Fax
(763) 772-0354
NPI assigned
Sep 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kris David Johnson, D.D.S.NPI 1881894137
Title
President
Phone
(763) 772-0330

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
Endodontics 1223E0200X D10585 MN Primary

Addresses

Primary practice location

11800 Aberdeen St NE
Suite 140
Blaine, MN 55449-4808

Mailing address

11800 Aberdeen St NE
Suite 140
Blaine, MN 55449-4808
Phone (763) 772-0330

National Provider Directory

National Provider Directory

Locations

11800 Aberdeen St NE
Ste 140
Blaine, MN 55449
Phone (763) 772-0330

Practitioners & affiliated clinicians

Practitioners 2

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": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932200037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 ABERDEEN ST NE",
            "address_2": "SUITE 140",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494808",
            "telephone_number": "763-772-0330",
            "fax_number": "763-772-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 ABERDEEN ST NE",
            "address_2": "SUITE 140",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494808",
            "telephone_number": "763-772-0330",
            "fax_number": "763-772-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND ENDODONTICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KRIS",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-772-0330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "D10585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.