Active NPI
Peter Marot Klinkenberg, DDS
- General Practice Dentistry
- Chaska, MN
National Provider Identifier
1003429465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D11461
- Practice address
- 1464 White Oak Dr
Chaska, MN 55318-2525 - Phone
- (952) 351-8282
- NPI assigned
- Aug 26, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D11461 | MN | Primary |
Addresses
Primary practice location
1464 White Oak Dr
Chaska, MN 55318-2525
Mailing address
4900 Old Cedar Lake Rd
St Louis Park, MN 55416-1647
Phone (612) 964-5865
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 |
|---|---|---|---|
| D11461 | MN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1003429465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4900 OLD CEDAR LAKE RD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161647",
"telephone_number": "612-964-5865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1464 WHITE OAK DR",
"city": "CHASKA",
"state": "MN",
"postal_code": "553182525",
"telephone_number": "952-351-8282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLINKENBERG",
"first_name": "PETER",
"middle_name": "MAROT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-26",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D11461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chaska, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.