Active NPI
Ipinder S Puri, DDS
- General Practice Dentistry
- Saint Paul, MN
National Provider Identifier
1073601449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12055
- Practice address
- 828 Hawthorne St E
Saint Paul, MN 55106-3252 - Phone
- (651) 774-2959
- Fax
- (651) 774-1997
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12055 | MN | Primary |
Addresses
Primary practice location
828 Hawthorne St E
Saint Paul, MN 55106-3252
Mailing address
828 Hawthorne St E
Saint Paul, MN 55106-3252
Phone (651) 774-2959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12055 | Other | MN | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12055 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073601449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "828 HAWTHORNE ST E",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551063252",
"telephone_number": "651-774-2959",
"fax_number": "651-774-1997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 HAWTHORNE ST E",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551063252",
"telephone_number": "651-774-2959",
"fax_number": "651-774-1997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PURI",
"first_name": "IPINDER",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "12055",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "12055",
"state": "MN"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.