NPIMap

Organization Active NPI

Main Street Family Dental Care P.a.

  • General Practice Dentistry
  • Saint Paul, MN
National Provider Identifier
1033170857
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9068 Issued in MN
Legal business name
MAIN STREET FAMILY DENTAL CARE P.A.
Practice address
411 Main St
Suite 308
Saint Paul, MN 55102-1080
Phone
(651) 227-6561
Fax
(651) 297-6852
NPI assigned
Mar 31, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Miss Jayne F. Grout
Title
Office Manager
Phone
(651) 227-6561

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 9068 MN Primary

Addresses

Primary practice location

411 Main St
Suite 308
Saint Paul, MN 55102-1080

Mailing address

411 Main St
Suite 308
Saint Paul, MN 55102-1080
Phone (651) 227-6561

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033170857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 MAIN ST",
            "address_2": "SUITE 308",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551021080",
            "telephone_number": "651-227-6561",
            "fax_number": "651-297-6852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 MAIN ST",
            "address_2": "SUITE 308",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551021080",
            "telephone_number": "651-227-6561",
            "fax_number": "651-297-6852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY DENTAL CARE P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GROUT",
        "authorized_official_first_name": "JAYNE",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "651-227-6561",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, 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.