Richard D Devorak, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10709 Issued in MN

Practice address

4325 Grand Ave
Duluth, MN 55807-2730

Phone

(218) 628-7035

Fax

(218) 624-6594

NPI assigned

Dec 12, 2006

Last updated

Jan 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: rdevorak813993@direct.ochin.org

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1982765319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 E 5TH ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548803709",
            "telephone_number": "715-392-1955",
            "fax_number": "715-392-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072730",
            "telephone_number": "218-628-7035",
            "fax_number": "218-624-6594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 3rd St",
            "address_purpose": "LOCATION",
            "city": "Carlton",
            "state": "MN",
            "postal_code": "557187703",
            "country_code": "US",
            "telephone_number": "218-336-3524",
            "fax_number": "218-384-9002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVORAK",
        "first_name": "RICHARD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christa H Deters, OTR
• Chloe Deutsch
• John Christopher Deutsch
• Sreedhar Devathi, M.D.
• Joey Lee Devlieger, PT
• Callie Sue Devriendt, LICSW
• Manita Dhungel, RN, CRNA
• Sara Rebecca Dhuse, PH.D.
• Tabitha Elizabeth Diamond
• Jenna Marie Dian, APRN, CNP

• General Practice Dentistry in Duluth, MN
• Providers in Duluth, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.