NPIMap

Organization Active NPI

Pine River Dental Arts, P.C.

  • General Practice Dentistry
  • Pine River, MN
National Provider Identifier
1962851071
Registry record updated Jun 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D13283 Issued in MN
Legal business name
PINE RIVER DENTAL ARTS, P.C.
Practice address
203 Park Ave
Pine River, MN 56474
Phone
(218) 587-4437
Fax
(218) 587-4479
NPI assigned
Jun 9, 2016
Last updated
Jun 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2016

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

Authorized official

Name
Jaime Lyn Preble, DDSNPI 1871932798
Title
Owner
Phone
(218) 587-4437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D13283 MN Primary

Addresses

Primary practice location

203 Park Ave
Pine River, MN 56474

Mailing address

PO Box 650
Pine River, MN 56474-0650
Phone (218) 587-4437

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465430400000",
    "number": "1962851071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650",
            "city": "PINE RIVER",
            "state": "MN",
            "postal_code": "564740650",
            "telephone_number": "218-587-4437",
            "fax_number": "218-587-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 PARK AVE",
            "city": "PINE RIVER",
            "state": "MN",
            "postal_code": "56474",
            "telephone_number": "218-587-4437",
            "fax_number": "218-587-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIVER DENTAL ARTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-09",
        "last_updated": "2016-06-09",
        "status": "A",
        "authorized_official_last_name": "PREBLE",
        "authorized_official_first_name": "JAIME",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-587-4437",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine River, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; 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.