Sedation & Implant Dentistry

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D9208 Issued in MN

Legal business name

SEDATION & IMPLANT DENTISTRY

Practice address

1815 Suburban Ave
Saint Paul, MN 55119-4302

Phone

(651) 735-4661

Fax

(651) 735-1910

NPI assigned

Apr 15, 2008

Organization subpart

No

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

Authorized official

Name

Karl Andrew Andreson, DDS

Title

Owner

Phone

(651) 735-4661

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1073787669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 SUBURBAN AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551194302",
            "telephone_number": "651-735-4661",
            "fax_number": "651-735-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 SUBURBAN AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551194302",
            "telephone_number": "651-735-4661",
            "fax_number": "651-735-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEDATION & IMPLANT DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "ANDRESON",
        "authorized_official_first_name": "KARL",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-735-4661",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D7091",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9766",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D9208",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D12228",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Periodontics in Minnesota

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