NPIMap

Organization Active NPI

Prairie Dental Group

  • General Practice Dentistry
  • Eden Prairie, MN
National Provider Identifier
1104057975
Registry record updated Jul 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PRAIRIE DENTAL GROUP
Practice address
6608 Flying Cloud Dr
Eden Prairie, MN 55344-3381
Phone
(952) 903-5000
Fax
(952) 944-0642
NPI assigned
Jul 28, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2009

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

Authorized official

Name
Ms. Caryl Leach
Title
Administrator
Phone
(952) 903-5000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

6608 Flying Cloud Dr
Eden Prairie, MN 55344-3381

Mailing address

6608 Flying Cloud Dr
Eden Prairie, MN 55344-3381
Phone (952) 903-5000

National Provider Directory

National Provider Directory

Locations

6608 Flying Cloud Dr
Eden Prairie, MN 55344
Phone (952) 903-5000

Practitioners & affiliated clinicians

Practitioners 6

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": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248739200000",
    "number": "1104057975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6608 FLYING CLOUD DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443381",
            "telephone_number": "952-903-5000",
            "fax_number": "952-944-0642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6608 FLYING CLOUD DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443381",
            "telephone_number": "952-903-5000",
            "fax_number": "952-944-0642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2009-07-28",
        "status": "A",
        "authorized_official_last_name": "LEACH",
        "authorized_official_first_name": "CARYL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "952-903-5000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; 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.