Active NPI
Derrick John Veneman, DDS
- Dentist
- Maplewood, MN
National Provider Identifier
1083761449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10146
- Practice address
- 1774 Cope Ave E Ste 110
Maplewood, MN 55109-2663 - Phone
- (651) 770-7175
- Fax
- (651) 770-6109
- NPI assigned
- Jan 5, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10146 | MN | Primary |
Addresses
Primary practice location
1774 Cope Ave E Ste 110
Maplewood, MN 55109-2663
Mailing address
1774 Cope Ave E Ste 110
Maplewood, MN 55109-2663
Phone (651) 770-7175
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10146 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395619200000",
"number": "1083761449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1774 COPE AVE E STE 110",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551092663",
"telephone_number": "651-770-7175",
"fax_number": "651-770-6109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1774 COPE AVE E STE 110",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551092663",
"telephone_number": "651-770-7175",
"fax_number": "651-770-6109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENEMAN",
"first_name": "DERRICK",
"middle_name": "JOHN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2014-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "10146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.