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DR. JONATHAN ISAK SIVERSON D.D.S.
NPI 1205030491
Dentist - General Practice in White Bear Lake, MN

Active since June 12, 2007PECOS Enrolled
4700 WHITE BEAR PKWY, WHITE BEAR LAKE, MN 55110(651) 762-7677(651) 762-1861 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Jonathan Isak Siverson D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JONATHAN ISAK SIVERSON D.D.S. (NPI 1205030491) is an individual general practice provider in White Bear Lake, Minnesota, licensed in Minnesota (D12410) and active in the NPI registry since June 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205030491
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. JONATHAN ISAK SIVERSONCredential: D.D.S.
Location Address4700 WHITE BEAR PKWYWhite Bear Lake, MN 55110-3336
Mailing Address1291 Niles AveSaint Paul, MN 55116-1632 · (612) 360-1713
Phone(651) 762-7677
Fax(651) 762-1861
Sole ProprietorYes
Enumeration DateJune 12, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1205030491 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in MN · D12410
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
4700 WHITE BEAR PKWY, White Bear Lake, MN 55110
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jonathan Isak Siverson D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55110 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JORDAN DITTBERNER DDS
Dentist (General Practice)
4700 WHITE BEAR PKWY
WHITE BEAR LAKE, MN 55110
Ramsey County (651) 762-7677
DR. DANIEL RICHARD ISAACSON DDS
Dentist (General Practice)
4700 WHITE BEAR PKWY
WHITE BEAR LAKE, MN 55110
Ramsey County (651) 762-7677
MICHAEL JULIUS WEISBROD DDS
Dentist (General Practice)
4700 WHITE BEAR PKWY
SAINT PAUL, MN 55110
Ramsey County (651) 762-7677
ISAACSON GENTLE DENTISTRY
Clinic/Center (Dental)
4700 WHITE BEAR PKWY
WHITE BEAR LAKE, MN 55110
Ramsey County (651) 762-7677
DR. CONNOR MICHAEL ISAACSON DDS
Dentist
4700 WHITE BEAR PKWY
WHITE BEAR LAKE, MN 55110
Ramsey County (651) 762-7677

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jonathan Siverson's NPI number?

The NPI number for Jonathan Siverson is 1205030491. It was assigned to this individual provider in the NPPES registry on June 12, 2007.

Where is Jonathan Siverson located?

Jonathan Siverson practices at 4700 White Bear Pkwy, White Bear Lake, MN 55110. The listed phone number is (651) 762-7677.

What is Jonathan Siverson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Jonathan Siverson enrolled in Medicare?

Yes. Jonathan Siverson is registered in the Medicare PECOS enrollment system.

What insurance does Jonathan Siverson accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Florida Combined Life and Humana and 2 other insurers list Jonathan Siverson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jonathan Siverson was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.