Abba Healthcare PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ABBA HEALTHCARE PLLC

Doing business as

Cottage Grove Pediatric Dentistry

Practice address

6936 Pine Arbor Dr S Ste 230
Cottage Grove, MN 55016-4645

Phone

(651) 204-5257

NPI assigned

Feb 12, 2024

Last updated

Feb 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ebosetale Okoruwa, DDSNPI 1417444332

Title

Owner Doctor

Phone

(712) 309-6588

Specialties & licenses 1

Addresses

Other names 1

• Cottage Grove Pediatric Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ebosetale Odiaogbe Okoruwa, DDS

  • Dentist
  • Cottage Grove, MN
  • NPI 1417444332
  NPD Authorized official

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1023872835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2052 IRENE ST",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551136613",
            "telephone_number": "712-309-6588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6936 PINE ARBOR DR S STE 230",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164645",
            "telephone_number": "651-204-5257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABBA HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "OKORUWA",
        "authorized_official_first_name": "EBOSETALE",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "712-309-6588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottage Grove Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Cottage Grove, MN
• Providers in Cottage Grove, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; 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.