NPIMap

Organization Active NPI

Nicollet Dental

  • Dentist
  • Minneapolis, MN
National Provider Identifier
1003108895
Registry record updated May 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D12104 Issued in MN
Legal business name
NICOLLET DENTAL
Practice address
6101 Nicollet Ave. So.
Minneapolis, MN 55419
Phone
(612) 866-8550
Fax
(612) 866-9453
NPI assigned
May 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2011

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

Authorized official

Name
Dr. Casey Lee Nelson, D.D.S.
Title
Owner
Phone
(612) 866-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D12104 MN Primary

Addresses

Primary practice location

6101 Nicollet Ave. So.
Minneapolis, MN 55419

Mailing address

6101 Nicollet Ave. So.
Minneapolis, MN 55419
Phone (612) 866-8550

National Provider Directory

National Provider Directory

Locations

6101 Nicollet Ave
Minneapolis, MN 55419
Phone (612) 866-8550

Practitioners & affiliated clinicians

Practitioners 1

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": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305072000000",
    "number": "1003108895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 NICOLLET AVE. SO.",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55419",
            "telephone_number": "612-866-8550",
            "fax_number": "612-866-9453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 NICOLLET AVE. SO.",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55419",
            "telephone_number": "612-866-8550",
            "fax_number": "612-866-9453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLLET DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2011-05-11",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "CASEY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-866-8550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; 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.