NPIMap

Organization Active NPI

Campodonico Family & Cosmetic Dentistry PC

  • General Practice Dentistry
  • Blaine, MN
National Provider Identifier
1104249259
Registry record updated Jan 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CAMPODONICO FAMILY & COSMETIC DENTISTRY PC
Practice address
11806 Aberdeen St NE
Suite 150
Blaine, MN 55449-4736
Phone
(763) 786-1545
Fax
(763) 786-2939
NPI assigned
Jan 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2014

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

Authorized official

Name
Dr. Carlos Ernesto Campodonico, DDSNPI 1154546877
Title
Owner
Phone
(763) 786-1545

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 1

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

Addresses

Primary practice location

11806 Aberdeen St NE
Suite 150
Blaine, MN 55449-4736

Mailing address

11806 Aberdeen St NE
Suite 150
Blaine, MN 55449-4736
Phone (763) 786-1545

Other identifiers 1

IdentifierTypeStateIssuer
1154546877OtherMNNPI

Other names 1

  • Arden Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

11806 Aberdeen St NE
Ste 150
Blaine, MN 55449
Phone (763) 786-1545

Practitioners & affiliated clinicians

Practitioners 2

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": "1390780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1104249259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11806 ABERDEEN ST NE",
            "address_2": "SUITE 150",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494736",
            "telephone_number": "763-786-1545",
            "fax_number": "763-786-2939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11806 ABERDEEN ST NE",
            "address_2": "SUITE 150",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494736",
            "telephone_number": "763-786-1545",
            "fax_number": "763-786-2939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPODONICO FAMILY & COSMETIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-27",
        "last_updated": "2014-01-27",
        "status": "A",
        "authorized_official_last_name": "CAMPODONICO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "ERNESTO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-786-1545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1154546877",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arden Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; 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.