NPIMap

Organization Active NPI

Dental Services Inc

  • General Practice Dentistry
  • Big Lake, MN
National Provider Identifier
1013069012
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D11353 Issued in MN
Legal business name
DENTAL SERVICES INC
Practice address
195 Jefferson Blvd
Big Lake, MN 55309-9572
Phone
(763) 263-2222
Fax
(763) 263-5822
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thanh H Pham, DDS
Title
Owner
Phone
(763) 263-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D11353 MN Primary

Addresses

Primary practice location

195 Jefferson Blvd
Big Lake, MN 55309-9572

Mailing address

195 Jefferson Blvd
Big Lake, MN 55309-9572
Phone (763) 263-2222

Other names 1

  • The Smile Center Doing business as

National Provider Directory

National Provider Directory

Locations

195 Jefferson Blvd
Big Lake, MN 55309
Phone (763) 263-2222

Practitioners & affiliated clinicians

Practitioners 10

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": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013069012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 JEFFERSON BLVD",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099572",
            "telephone_number": "763-263-2222",
            "fax_number": "763-263-5822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 JEFFERSON BLVD",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099572",
            "telephone_number": "763-263-2222",
            "fax_number": "763-263-5822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "THANH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-263-2222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Smile Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Big Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.