NPIMap

Organization Active NPI

Jack M. Fiedler, D.D.S.,P.a.

Doing business as d/b/a Esthetic Family Dentistry

  • General Practice Dentistry
  • Hector, MN
National Provider Identifier
1982908000
Registry record updated Jan 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D12373 Issued in MN
Legal business name
JACK M. FIEDLER, D.D.S.,P.A.
Doing business as
d/b/a Esthetic Family Dentistry
Practice address
150 Greenwood Ave W
Box 547
Hector, MN 55342
Phone
(320) 848-2611
Fax
(320) 848-2611
NPI assigned
Jan 4, 2011
Last updated
Jan 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2011

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

Authorized official

Name
Dr. Jack M. Fiedler, D.D.S.NPI 1720140437
Title
Owner
Phone
(320) 848-2611

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 Dentistry 1223G0001X D12373 MN Primary

Addresses

Primary practice location

150 Greenwood Ave W
Box 547
Hector, MN 55342

Mailing address

150 Greenwood Ave W
Box 547
Hector, MN 55342
Phone (320) 848-2611

Other names 1

  • d/b/a Esthetic Family Dentistry Doing business as

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": "1294099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294099200000",
    "number": "1982908000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 GREENWOOD AVE W",
            "address_2": "BOX 547",
            "city": "HECTOR",
            "state": "MN",
            "postal_code": "55342",
            "telephone_number": "320-848-2611",
            "fax_number": "320-848-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 GREENWOOD AVE W",
            "address_2": "BOX 547",
            "city": "HECTOR",
            "state": "MN",
            "postal_code": "55342",
            "telephone_number": "320-848-2611",
            "fax_number": "320-848-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK M. FIEDLER, D.D.S.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-04",
        "last_updated": "2011-01-04",
        "status": "A",
        "authorized_official_last_name": "FIEDLER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-848-2611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a Esthetic Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hector, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; 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.