Nicollet 38TH St Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9005 Issued in MN

Legal business name

NICOLLET 38TH ST DENTAL

Practice address

17 E 38TH St
Minneapolis, MN 55409-1341

Phone

(612) 825-7835

Fax

(612) 825-3819

NPI assigned

Jun 19, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Charles W Sims, DDS

Title

Dentist / Owner

Phone

(612) 825-7835

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1043471337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 E 38TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091341",
            "telephone_number": "612-825-7835",
            "fax_number": "612-825-3819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 E 38TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554091341",
            "telephone_number": "612-825-7835",
            "fax_number": "612-825-3819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLLET 38TH ST DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DENTIST / OWNER",
        "authorized_official_telephone_number": "612-825-7835",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA",
            "identifier": "143320200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI DR SIMS",
            "identifier": "156718700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI DR WILLIAMS",
            "identifier": "1568465441",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI DR WARREN",
            "identifier": "1174638613",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA",
            "identifier": "156718700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Jo Nicol, CPNP-PC
• Sue Nicol, LPN, PHD
• Nicole J Wolf PHD LP
• Nicole Petersen Well-Being LLC
• Narysse Nicolet, MD
• Nicollet Avenue Dental, PLLC
• Nicollet Chiropractic Center
• Nicollet Dental
• Nicollet Mall Dental Arts PLLC
• Nicollet Pharmacy LLC

• General Practice Dentistry in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.