Minnehaha Fall Family Dental

Primary specialty

DentistTaxonomy code 122300000X

License

10142 Issued in MN

Legal business name

MINNEHAHA FALL FAMILY DENTAL

Practice address

4554 Minnehaha Ave
Minneapolis, MN 55406

Phone

(612) 721-3012

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Jenna Lynn Swenson, DDSNPI 1811337751

Title

Owner

Phone

(320) 761-2259

Specialties & licenses 1

Addresses

Other names 1

• Jakubas Dental Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jenna Lynn Swenson, D.D.S

  • General Practice Dentistry
  • Minneapolis, MN
  • NPI 1811337751
  NPD Authorized official

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609372800000",
    "number": "1104977222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4554 MINNEHAHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55406",
            "telephone_number": "612-721-3012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4554 MINNEHAHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55406",
            "telephone_number": "612-721-3012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNEHAHA FALL FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A",
        "authorized_official_last_name": "SWENSON",
        "authorized_official_first_name": "JENNA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-761-2259",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "10142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jakubas Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Minnesota Behavioral Health Services LLC

• Dentist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; 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.