NPIMap

Organization Active NPI

Edina 5-O Dental PA

  • Dentist
  • Edina, MN
National Provider Identifier
1083789929
Registry record updated Jul 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D10569 Issued in MN
Legal business name
EDINA 5-O DENTAL PA
Practice address
3948 W 50TH St
Suite 205
Edina, MN 55424
Phone
(952) 922-8111
Fax
(952) 922-2125
NPI assigned
Nov 22, 2006
Organization subpart
Yes
Parent organization
EDINA 5-O DENTAL PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2008

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

Authorized official

Name
Dr. Drew F Spencer, DDSNPI 1194888735
Title
Dentist Owner
Phone
(952) 922-8111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D10569 MN Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 10569 MN

Addresses

Primary practice location

3948 W 50TH St
Suite 205
Edina, MN 55424

Mailing address

3948 W 50TH St
Suite 205
Edina, MN 55424
Phone (952) 922-8111

Other names 1

  • Drew F Spencer DDS Other name

National Provider Directory

National Provider Directory
Part of
Edina 5-O Dental PA

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1083789929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3948 W 50TH ST",
            "address_2": "SUITE 205",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55424",
            "telephone_number": "952-922-8111",
            "fax_number": "952-922-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3948 W 50TH ST",
            "address_2": "SUITE 205",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55424",
            "telephone_number": "952-922-8111",
            "fax_number": "952-922-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDINA 5-O DENTAL PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDINA 5-O DENTAL PA",
        "enumeration_date": "2006-11-22",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "DREW",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "952-922-8111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10569",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10569",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drew F Spencer DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.