Advanced Dental Care Services

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D 11855 Issued in MN

Legal business name

ADVANCED DENTAL CARE SERVICES

Practice address

2363 Commerce Blvd
Mound, MN 55364-1425

Phone

(952) 472-1182

NPI assigned

Nov 17, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mazen Manla, DDSNPI 1447324926

Title

Dentist

Phone

(952) 472-1182

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mazen Manla, DDS

  • General Practice Dentistry
  • Mound, MN
  • NPI 1447324926
  NPD (past) Authorized official

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083788574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2363 COMMERCE BLVD",
            "city": "MOUND",
            "state": "MN",
            "postal_code": "553641425",
            "telephone_number": "952-472-1182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2363 COMMERCE BLVD",
            "city": "MOUND",
            "state": "MN",
            "postal_code": "553641425",
            "telephone_number": "952-472-1182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANLA",
        "authorized_official_first_name": "MAZEN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "952-472-1182",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D 11855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aegis Group Practice LLC
• Joanna Nicole Anderson, OTR/L
• Grant U Anderton, PHARMD
• Bianca Bakardieva Ramos Da Silva, MA, LPCC, LADC
• James Michael Baldus, PH.D., L.P.

• General Practice Dentistry in Mound, MN
• Providers in Mound, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.