Grove Endodontics, P.a.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D10981 Issued in MN

Legal business name

GROVE ENDODONTICS, P.A.

Practice address

8811 92ND St S
Suite 109
Cottage Grove, MN 55016-4036

Phone

(651) 768-8180

Fax

(651) 768-8184

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Thomas W Waldron, D.D.S.NPI 1184681462

Title

President

Phone

(651) 768-8180

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.

• Thomas W Waldron, D.D.S.

  • Endodontics
  • Cottage Grove, MN
  • NPI 1184681462
  NPD (past) Authorized official

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083789507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8811 92ND ST S",
            "address_2": "SUITE 109",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164036",
            "telephone_number": "651-768-8180",
            "fax_number": "651-768-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8811 92ND ST S",
            "address_2": "SUITE 109",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164036",
            "telephone_number": "651-768-8180",
            "fax_number": "651-768-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROVE ENDODONTICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-768-8180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "D10981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endodontics in Cottage Grove, MN
• Providers in Cottage Grove, MN by specialty
• Endodontics 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.