NORTHERN LAKES DENTAL - RIVERFRONT, LLC (NPI# 1013554310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013554310 |
| Entity Type | Organization |
| Organization Name | NORTHERN LAKES DENTAL - RIVERFRONT, LLC |
| Practice Address |
124 E Lincoln Ave Fergus Falls MN 56537-2217 |
| Mailing Address |
1108 Western Ave Fergus Falls MN 56537-4808 |
| Practice Telephone | 2187365627 |
| Practice Fax Number | 2187366955 |
| Mailing Telephone | 2187364000 |
| Mailing Fax Number | 2187360766 |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2019-12-05 |
| Authorized Official Name | CATIE SUE BAGLO (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Telephone | 2187364000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
124 E LINCOLN AVE |
| City | FERGUS FALLS |
| State | MN |
| Zip Code | 56537-2217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740306802 | Grant Robert Colling | Dentist | 124 E Lincoln Ave, Fergus Falls, MN 56537-2217 | 2007-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295334217 | Mary Jane Andersen | Pharmacist | 3300 Hwy 210 W, Fergus Falls, MN 56537 | 2020-10-21 |
| 1609475615 | Blaine Perry Ecker | Pharmacist | 3300 Highway 210 W., 3300 Highway 210 West, Fergus Falls, MN 56537 | 2020-10-21 |
| 1336771591 | Paul George Wawin | Psychiatry & Neurology | 712 Cascade St. S. Lake Region Healthcare, Fergus Falls, MN 56537 | 2020-02-06 |
| 1134604127 | Christopher Michael Kjolhaug | Physical Therapist | 1131 South Mabelle Ave, Fergus Falls, MN 56537 | 2018-09-26 |
| 1619406808 | Aaron John Teigen | Physical Therapist | 1304 Lincoln Ave W, Suite C, Fergus Falls, MN 56537 | 2017-06-09 |
| 1003272154 | Anthony Gettel Dc LLC | Chiropractor | 755 Wildwood Trail, Fergus Falls, MN 56537 | 2016-01-05 |
| 1447628912 | Kelsey Shea | Student in an Organized Health Care Education/Training Program | 20743 Red Oak Dr., Fergus Falls, MN 56537 | 2015-09-14 |
| 1881070217 | Vineet Ganapati | Dentist | 2001 W Lincoln Ave # 33, Fergus Falls, MN 56537 | 2015-08-07 |
| 1497004832 | Beverly Renae Reiff | Registered Nurse | 22279 River Oaks Drive, Fergus Falls, MN 56537 | 2012-08-30 |
| 1114221421 | Jane Mary Bjornson | Social Worker | 21081 County Hwy 1, Fergus Falls, MN 56537 | 2010-12-29 |
| Find all providers in zip 56537 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770197030 | Kelly I Schroeder Dds | Clinic/Center | 1108 Western Ave, Fergus Falls, MN 56537-4808 | 2020-09-03 |
| 1033723309 | Scott Wagnild Dds,llc | Clinic/Center | 1108 Western Ave, Fergus Falls, MN 56537-4808 | 2020-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033710025 | Theresa M. Snell | Clinic/Center | 580 5th Ave Nw Ste 100, New Brighton, MN 55112-2836 | 2020-11-05 |
| 1376143248 | James M. Williams, D.d.s., P.a. | Clinic/Center | 620 Union St S, Mora, MN 55051-1818 | 2020-10-29 |
| 1235746058 | Asp Dental, PC | Clinic/Center | 17705 Hutchins Dr Ste 201, Minnetonka, MN 55345-4103 | 2020-09-25 |
| 1952918781 | Asp Dental, PC | Clinic/Center | 9800 Shelard Pkwy Ste 130, Plymouth, MN 55441-6451 | 2020-09-25 |
| 1518574532 | Stillwater Family Dental | Clinic/Center | 13481 60th St N Ste 100, Oak Park Heights, MN 55082-1089 | 2020-09-24 |
| 1093321531 | Barnett Dental Inc | Clinic/Center | 7962 Sunwood Dr Nw Ste 200, Ramsey, MN 55303-5172 | 2020-09-21 |
| 1356955868 | Todd A Brewer Dds Pllc | Clinic/Center | 603 Jefferson Ave Sw, Watertown, MN 55388 | 2020-09-02 |
| 1770195158 | Mark T. Sherman Dds Pa | Clinic/Center | 31011 Rasmussen Rd, Pequot Lakes, MN 56472-1227 | 2020-08-18 |
| 1689286015 | Lifelong Dental Care | Clinic/Center | 1525 Livingston Ave Ste B, West St Paul, MN 55118-3430 | 2020-08-18 |
| 1528678497 | Custom Smiles Dentistry, Pllc | Clinic/Center | 2258 Bunker Lake Blvd Nw, Andover, MN 55304-3900 | 2020-08-05 |
| Find all providers with the same taxonomy | ||||
| City | FERGUS FALLS |
| Zip Code | 56537 |
Please comment or provide details below to improve the information on NORTHERN LAKES DENTAL - RIVERFRONT, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.