University Ave Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

UNIVERSITY AVE DENTAL, PLLC

Practice address

10155 University Ave NE Ste 112
Blaine, MN 55434-8058

Phone

(763) 784-1242

NPI assigned

Feb 1, 2022

Organization subpart

No

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

Authorized official

Name

Marty Spanish, DDS

Title

Owner

Phone

(952) 836-7924

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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

• Taylor Johnson

  • General Practice Dentistry
  • Blaine, MN
  • NPI 1396398160
  NPD
• Don R Blakeslee, DDS

  • Dentist
  • Blaine, MN
  • NPI 1790883130
  NPD (past)
• Logan Keith Connor, DMD

  • General Practice Dentistry
  • Brooklyn Center, MN
  • NPI 1043053796
  NPD (past)

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1093468852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10155 UNIVERSITY AVE NE STE 112",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554348058",
            "telephone_number": "763-784-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10155 UNIVERSITY AVE NE STE 112",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554348058",
            "telephone_number": "763-784-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY AVE DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "SPANISH",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-836-7924",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Twin City Care
• Twin Horizons Services L.L.C.
• Twin Lake Transportation LLC
• U.S. Healthworks Medical Group of Minnesota, PC
• Universer Healthcare Services LLC
• Jennifer Lynn Urbach, MA, LPCC
• V Mental Wellness, PLLC
• Taylor Kristine Vacca, MA, BS
• Bao Vang
• Christelle Vang, D.C.

• General Practice Dentistry in Blaine, MN
• Providers in Blaine, 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 Feb 1, 2022; 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.