GLACIAL LAKES DENTAL, PLLP (NPI# 1184923096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184923096 |
| Entity Type | Organization |
| Organization Name | GLACIAL LAKES DENTAL, PLLP |
| Practice Address |
509 16th Ave Sw Willmar MN 56201-4118 |
| Practice Telephone | 3202357742 |
| Practice Fax Number | 3202354045 |
| Mailing Telephone | 3202357742 |
| Mailing Fax Number | 3202354045 |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2011-03-17 |
| Authorized Official Name | MRS. DAWN RENAE PLATT (OFFICE MANAGER) |
| Authorized Official Telephone | 3202357742 |
| 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 |
509 16TH AVE SW |
| City | WILLMAR |
| State | MN |
| Zip Code | 56201-4118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508817586 | John Paul Iverson | Dentist | 509 16th Ave Sw, Willmar, MN 56201-4118 | 2006-05-13 |
| 1861546855 | Southwest Professional Inc | Dentist | 509 16th Ave Sw, Willmar, MN 56201-4118 | 2007-01-23 |
| 1801969803 | Stephen Mark Medin | Dentist | 509 16th Ave Sw, Willmar, MN 56201-4118 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730793472 | Sarah Erickson | Counselor | 2120 60th Ave N.w., Willmar, MN 56201 | 2020-09-01 |
| 1417560681 | Amy Engle | Nurse Practitioner | 1125 Se 8th Street, Willmar, MN 56201 | 2020-08-28 |
| 1154856524 | Mude Transportation Inc | Non-emergency Medical Transport (VAN) | 1712 Monongalia Ave Sw Ap1, Willmar, MN 56201 | 2017-04-24 |
| 1285025874 | Jill Fellows | Occupational Therapist | 611 5th St. Sw, Willmar, MN 56201 | 2015-02-18 |
| 1700294881 | Brenda Wiese | Counselor | 1617 Hwy 12 E, Suite 230, Willmar, MN 56201 | 2014-08-01 |
| 1275955932 | Courtney Regnier | Marriage & Family Therapist | 2320 E Hwy 12 Ste 2, Willmar, MN 56201 | 2014-01-15 |
| 1568732402 | Pamela Jean Kubesh | Social Worker | 328 Sw 3rd Street, Willmar, MN 56201 | 2012-01-10 |
| 1699931824 | Community Behavioral Health Hospital-willmar | Psychiatric Hospital | 1208 Olena Ave Se, Willmar, MN 56201 | 2008-08-07 |
| 1700053345 | Nathan Schrick | Marriage & Family Therapist | 513 Sw 5th Street, Box 1810, Willmar, MN 56201 | 2008-05-13 |
| 1831381680 | Joan M Blonigan Christianson | Chiropractor | 1101 S 1st Street, Willmar, MN 56201 | 2007-08-15 |
| Find all providers in zip 56201 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003329574 | Carris Health LLC | Clinic/Center | 301 Becker Ave Sw, Willmar, MN 56201-3302 | 2017-11-07 |
| 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 | ||||
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| 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.