NPIMap

Organization Active NPI

Dental Specialists of Minnesota, PLLC

  • Periodontics
  • Fridley, MN
National Provider Identifier
1003245333
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
DENTAL SPECIALISTS OF MINNESOTA, PLLC
Practice address
1109 Moore Lake Dr E
Fridley, MN 55432-5171
Phone
(763) 571-9990
Fax
(763) 572-2226
NPI assigned
Nov 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Authorized official

Name
Dr. Alan Law
Title
President
Phone
(651) 633-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

1109 Moore Lake Dr E
Fridley, MN 55432-5171

Mailing address

2200 County Road C W
Suite 2210
Roseville, MN 55113-2550
Phone (651) 633-0500

Other names 1

  • The Dental Specialists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Specialists of Minnesota PLLC30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1003245333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W",
            "address_2": "SUITE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132550",
            "telephone_number": "651-633-0500",
            "fax_number": "651-636-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 MOORE LAKE DR E",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325171",
            "telephone_number": "763-571-9990",
            "fax_number": "763-572-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SPECIALISTS OF MINNESOTA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-07",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "LAW",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-633-0500",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dental Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.