NPIMap

Organization Active NPI

Dakota Dental Clinic PA

  • General Practice Dentistry
  • Apple Valley, MN
National Provider Identifier
1063559540
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9428 Issued in MN
Legal business name
DAKOTA DENTAL CLINIC PA
Practice address
14682 Pennock Ave
Apple Valley, MN 55124-7429
Phone
(952) 431-5774
Fax
(952) 431-0862
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Authorized official

Name
Dr. Bennett Isabella, DDSNPI 1174781702
Title
President
Phone
(952) 431-5774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D9428 MN Primary

Addresses

Primary practice location

14682 Pennock Ave
Apple Valley, MN 55124-7429

Mailing address

14682 Pennock Ave
Apple Valley, MN 55124-7429
Phone (952) 431-5774

National Provider Directory

National Provider Directory

Locations

14682 Pennock Ave
Saint Paul, MN 55124
Phone (952) 431-5774

Practitioners & affiliated clinicians

Practitioners 5

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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1063559540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14682 PENNOCK AVE",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247429",
            "telephone_number": "952-431-5774",
            "fax_number": "952-431-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14682 PENNOCK AVE",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247429",
            "telephone_number": "952-431-5774",
            "fax_number": "952-431-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAKOTA DENTAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "ISABELLA",
        "authorized_official_first_name": "BENNETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-431-5774",
        "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": "D9428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.