NPIMap

Organization Active NPI

Minnesota Dental Professionals, P.C.

Doing business as Pilot Knob Dental Care

  • Dentist
  • Lakeville, MN
National Provider Identifier
1043715204
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MINNESOTA DENTAL PROFESSIONALS, P.C.
Doing business as
Pilot Knob Dental Care
Practice address
16138 Pilot Knob Rd
Lakeville, MN 55044
Phone
(952) 679-7779
Fax
(952) 679-7778
NPI assigned
Mar 28, 2018
Last updated
Jun 5, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MINNESOTA DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Authorized official

Name
Jessica Britt
Title
Credentialing Coordinator
Phone
(217) 540-8426

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

16138 Pilot Knob Rd
Lakeville, MN 55044

Mailing address

16138 Pilot Knob Rd
Lakeville, MN 55044-4105
Phone (952) 679-7779

Other practice location 1

16138 Pilot Knob Rd
Lakeville, MN 55044-4105
Phone (612) 354-8875

Other names 1

  • Pilot Knob Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Dental Professionals PC23 organizations share this tax ID, including this one
Part of
Minnesota Dental Professionals PC

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

16138 Pilot Knob Rd
Lakeville, MN 55044
Phone (952) 248-4674

Practitioners & affiliated clinicians

Practitioners 5

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": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1043715204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16138 PILOT KNOB RD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550444105",
            "telephone_number": "952-679-7779",
            "fax_number": "952-679-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16138 PILOT KNOB RD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "55044",
            "telephone_number": "952-679-7779",
            "fax_number": "952-679-7778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16138 Pilot Knob Rd",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550444105",
            "country_code": "US",
            "telephone_number": "612-354-8875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2018-03-28",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8426"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pilot Knob Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; 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.