FOND DU LAC RESERVATION BUSINESS COMMITTE (NPI# 1063723138) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063723138 |
| Entity Type | Organization |
| Organization Name | FOND DU LAC RESERVATION BUSINESS COMMITTE |
| Other Organization Name | FOND DU LAC HUMAN SERVICES DIVISION DENTAL CLINIC |
| Practice Address |
927 Trettel Lane Fond Du Lac Human Services Division Dental Clinic Cloquet MN 55720 |
| Practice Telephone | 2188791227 |
| Practice Fax Number | 2188783755 |
| Mailing Telephone | 2188791227 |
| Mailing Fax Number | 2188783755 |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2010-06-23 |
| Authorized Official Name | KAREN R DIVER (CHAIRWOMAN) |
| Authorized Official Telephone | 2188794593 |
| Is Organization Subpart | Y |
| Parent Organization Name | FOND DU LAC RESERVATION BUSINESS COMMITTEE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
MN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 666815100 | 05 |
| Other Name | Type Code |
|---|---|
| Fond du Lac Human Services Division Dental Clinic | Doing Business As Name - Organization |
| Street Address |
927 TRETTEL LANE FOND DU LAC HUMAN SERVICES DIVISION DENTAL CLINIC |
| City | CLOQUET |
| State | MN |
| Zip Code | 55720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912961228 | Mollie A Stapleton | Family Medicine | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2006-04-13 |
| 1225335862 | Fond Du Lac Reservation Business Committee | Clinic/Center | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2011-02-17 |
| 1457669764 | Debra Marie Smith | Registered Nurse | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2010-09-21 |
| 1881906287 | Jamie Wade | Dentist | 927 Trettel Lane, Fond Du Lac Human Services Division927 Trettel Lane, Cloquet, MN 55720 | 2010-07-14 |
| 1770725582 | Ben Earl Anderson | Pharmacist | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720-8247 | 2009-03-26 |
| 1700026143 | Jamie Johanna Kraus | Pharmacist | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2009-02-25 |
| 1225278674 | Jessica Anne Linde | Pharmacist | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2009-02-25 |
| 1205090321 | Jeanne Rice | Optometrist | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2008-07-17 |
| 1598928681 | Elenore C Schoenfeld | Counselor | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2008-07-08 |
| 1184887267 | Jeffery Agoton-howes | Social Worker | 927 Trettel Lane, Fond Du Lac Human Services Division, Cloquet, MN 55720 | 2008-07-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447786652 | Awakening Growth, LLC | Social Worker | 116 Ave C, Cloquet, MN 55720 | 2017-05-08 |
| 1396129706 | Kara Danielle Ebert | Marriage & Family Therapist | 913 Stanley Ave, Cloquet, MN 55720 | 2015-07-15 |
| 1639577729 | Fcsl Cloquet, LLC | Assisted Living Facility | 130 W North Road, Cloquet, MN 55720 | 2014-12-05 |
| 1699173765 | Fcsl Cloquet, LLC | Assisted Living Facility | 132 W North Road, Cloquet, MN 55720 | 2014-12-05 |
| 1134426778 | Fond Du Lac Reservation Business Committee | Assisted Living Facility | 1571 Airport Road, Fond Du Lac Assisted Living, Cloquet, MN 55720 | 2011-02-17 |
| 1417124553 | Kara Lynn Fausch | Family Medicine | 512 Skyline Boulevard, Cloquet, MN 55720 | 2008-05-08 |
| 1013199769 | Carlton Co Public Health & Human Services | Public Health or Welfare | 30 N 10th Street, Cloquet, MN 55720 | 2007-12-04 |
| 1881808616 | Stephen David Parkhurst | Chiropractor | 903 Cloquet Avenue, Cloquet, MN 55720 | 2007-05-10 |
| 1093929861 | Northland Afc,inc | Day Training, Developmentally Disabled Services | 1576 White Pine Trail, Cloquet, MN 55720 | 2007-05-10 |
| 1235341231 | Northland Afc,inc | Day Training, Developmentally Disabled Services | 6580 W Arrowhead Rd., Cloquet, MN 55720 | 2007-05-04 |
| Find all providers in zip 55720 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| 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 |
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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.