NPIMap

Organization Active NPI

Family Orthodontic Specialists PLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • St Louis Park, MN
National Provider Identifier
1104569839
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
FAMILY ORTHODONTIC SPECIALISTS PLC
Practice address
4959 Excelsior Blvd Ste 200
St Louis Park, MN 55416-3003
Phone
(952) 920-8774
Fax
(952) 920-8979
NPI assigned
Apr 20, 2022
Organization subpart
Yes
Parent organization
FAMILY ORTHODONTIC SPECIALISTS PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

4959 Excelsior Blvd Ste 200
St Louis Park, MN 55416-3003

Mailing address

4959 Excelsior Blvd Ste 200
St Louis Park, MN 55416-3003
Phone (952) 920-8774

Other names 1

  • Woodlake Orthodontics St Louis Park Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family Orthodontic Specialists PLC10 organizations share this tax ID, including this one
Part of
Family Orthodontic Specialists PLC

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1104569839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4959 EXCELSIOR BLVD STE 200",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554163003",
            "telephone_number": "952-920-8774",
            "fax_number": "952-920-8979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4959 EXCELSIOR BLVD STE 200",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554163003",
            "telephone_number": "952-920-8774",
            "fax_number": "952-920-8979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY ORTHODONTIC SPECIALISTS PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY ORTHODONTIC SPECIALISTS PLC",
        "enumeration_date": "2022-04-20",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodlake Orthodontics St Louis Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

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