NPIMap

Organization Active NPI

Donabauer Family Dentistry, PC

  • Dental Clinic/Center
  • Moorhead, MN
National Provider Identifier
1992964530
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
11563 Issued in MN
Legal business name
DONABAUER FAMILY DENTISTRY, PC
Practice address
211 5TH St S
Moorhead, MN 56560-2714
Phone
(218) 233-1754
Fax
(218) 291-1640
NPI assigned
Jun 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Dr. Bradly J Donabauer
Title
President
Phone
(218) 233-1754

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 11563 MN Primary

Addresses

Primary practice location

211 5TH St S
Moorhead, MN 56560-2714

Mailing address

211 5TH St S
Moorhead, MN 56560-2714
Phone (218) 233-1754

National Provider Directory

National Provider Directory

Locations

211 5th St S
Moorhead, MN 56560
Phone (218) 233-0429

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1992964530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 5TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602714",
            "telephone_number": "218-233-1754",
            "fax_number": "218-291-1640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 5TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602714",
            "telephone_number": "218-233-1754",
            "fax_number": "218-291-1640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DONABAUER FAMILY DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "DONABAUER",
        "authorized_official_first_name": "BRADLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-233-1754",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "11563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.