NPIMap

Organization Active NPI

Dentalign P.a.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Maple Grove, MN
National Provider Identifier
1003174764
Registry record updated May 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D11493 Issued in MN
Legal business name
DENTALIGN P.A.
Practice address
7860 Main St
Maple Grove, MN 55369
Phone
(763) 420-1030
NPI assigned
May 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2012

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

Authorized official

Name
Chad Holly Kelly, D.M.D.
Title
President
Phone
(612) 701-0478

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X D11493 MN Primary

Addresses

Primary practice location

7860 Main St
Maple Grove, MN 55369

Mailing address

4630 Edgebrook PL
Edina, MN 55424
Phone (612) 701-0478

National Provider Directory

National Provider Directory
Tax ID family
Dentalign PA6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335830400000",
    "number": "1003174764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 EDGEBROOK PL",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55424",
            "telephone_number": "612-701-0478",
            "fax_number": "763-450-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7860 MAIN ST",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-420-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTALIGN P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-05-01",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "HOLLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-701-0478",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "D11493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; 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.