NPIMap

Organization Active NPI

Family & Cosmetic Gentle Dentistry, LTD

  • General Practice Dentistry
  • Eagan, MN
National Provider Identifier
1093997546
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAMILY & COSMETIC GENTLE DENTISTRY, LTD
Practice address
1340 Duckwood Dr
Eagan, MN 55123-2324
Phone
(651) 209-9999
Fax
(651) 209-0396
NPI assigned
Nov 27, 2007
Organization subpart
Yes
Parent organization
FAMILY & COSMETIC GENTLE DENTISTRY, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Diana Gavic
Title
Operations Manager
Phone
(952) 224-9771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1340 Duckwood Dr
Eagan, MN 55123-2324

Mailing address

6600 France Ave S Ste 415
Edina, MN 55435-1817
Phone (952) 224-9771

Other identifiers 1

IdentifierTypeStateIssuer
625193500MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Family Cosmetic Gentle Dentistry LTD16 organizations share this tax ID, including this one
Part of
Family Cosmetic Gentle Dentistry LTD

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

1340 Duckwood Dr
Eagan, MN 55123
Phone (651) 209-9999

6600 France Ave S
Ste 415
Minneapolis, MN 55435
Phone (952) 303-6832

Practitioners & affiliated clinicians

Practitioners 3

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": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1093997546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 415",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351817",
            "telephone_number": "952-224-9771",
            "fax_number": "952-224-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 DUCKWOOD DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232324",
            "telephone_number": "651-209-9999",
            "fax_number": "651-209-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & COSMETIC GENTLE DENTISTRY, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY & COSMETIC GENTLE DENTISTRY, LTD",
        "enumeration_date": "2007-11-27",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "GAVIC",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "952-224-9771"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "625193500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.