Active NPI
Jennifer Lynn Bonamici, DDS
- Dentist
- Minneapolis, MN
National Provider Identifier
1003300583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- R708
- Practice address
- 515 Delaware St SE
Minneapolis, MN 55455-0357 - Phone
- (612) 625-5000
- NPI assigned
- Jun 19, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | R708 | MN | Primary |
Addresses
Primary practice location
515 Delaware St SE
Minneapolis, MN 55455-0357
Mailing address
240 Chicago Avenue South
Apartment 338
Minneapolis, MN 55415
Phone (734) 626-9256
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R708 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529366400000",
"number": "1003300583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 CHICAGO AVENUE SOUTH",
"address_2": "APARTMENT 338",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55415",
"telephone_number": "734-626-9256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 DELAWARE ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550357",
"telephone_number": "612-625-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONAMICI",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-19",
"last_updated": "2018-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "MN",
"license": "R708",
"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 Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.