Individual provider Active NPI

Roberta Santos Souza Dias, DDS

  • Dentist
  • Duluth, MN
National Provider Identifier
1093698573
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D15335 Issued in MN
Practice address
320 W Myrtle St Ste 100
Duluth, MN 55811-4457
Phone
(218) 491-8058
NPI assigned
Jul 30, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D15335 MN Primary

Addresses

Primary practice location

320 W Myrtle St Ste 100
Duluth, MN 55811-4457

Mailing address

3120 Northdale Blvd NW Unit 427
Coon Rapids, MN 55433-3020
Phone (651) 342-3678

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

LicenseStateTypeSpecialty
D15335MNMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1753833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1093698573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 NORTHDALE BLVD NW UNIT 427",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333020",
            "telephone_number": "651-342-3678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 W MYRTLE ST STE 100",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558114457",
            "telephone_number": "218-491-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS SOUZA DIAS",
        "first_name": "ROBERTA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-30",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D15335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; 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.