NPIMap

Organization Active NPI

State of Minnesota Minnesota Management and Budget

  • General Practice Dentistry
  • Silver Bay, MN
National Provider Identifier
1083310403
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
STATE OF MINNESOTA MINNESOTA MANAGEMENT AND BUDGET
Practice address
56 Outer Dr
Silver Bay, MN 55614-1133
Phone
(218) 353-8700
Fax
(612) 548-5964
NPI assigned
Feb 7, 2023
Organization subpart
Yes
Parent organization
STATE OF MINNESOTA MINNESOTA MANAGEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Simone Renee Hogan
Title
Mdva Chief Operations Director
Phone
(612) 505-4110

Specialties & licenses 1

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

Addresses

Primary practice location

56 Outer Dr
Silver Bay, MN 55614-1133

Mailing address

5101 Minnehaha Ave. S
Minneapolis, MN 55417-1647

Other names 1

  • Minnesota Veterans Homes Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Correctional Facility -Togo28 organizations share this tax ID, including this one
Part of
Minnesota Correctional Facility -Togo

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1083310403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 MINNEHAHA AVE. S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 OUTER DR",
            "city": "SILVER BAY",
            "state": "MN",
            "postal_code": "556141133",
            "telephone_number": "218-353-8700",
            "fax_number": "612-548-5964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MINNESOTA MINNESOTA MANAGEMENT AND BUDGET",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MINNESOTA MINNESOTA MANAGE",
        "enumeration_date": "2023-02-07",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "HOGAN",
        "authorized_official_first_name": "SIMONE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "MDVA CHIEF OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "612-505-4110"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Veterans Homes Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Silver Bay, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.