Northwest Family Dental Center TN

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8424 Issued in MN

Legal business name

NORTHWEST FAMILY DENTAL CENTER TN

Practice address

12725 43Rd St NE
Suite 202
Saint Michael, MN 55376-4900

Phone

(763) 497-2367

Fax

(763) 497-8171

NPI assigned

May 7, 2007

Organization subpart

No

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

Authorized official

Name

David A. Desimone, D.D.S.NPI 1982789731

Title

Owner

Phone

(763) 497-2367

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• David Albert Desimone, D.D.S.

  • General Practice Dentistry
  • Saint Michael, MN
  • NPI 1982789731
  NPD (past) Authorized official
• Eric Todd Carlson, DDS

  • General Practice Dentistry
  • Saint Michael, MN
  • NPI 1902965890
  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114130010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12725 43RD ST NE",
            "address_2": "SUITE 202",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553764900",
            "telephone_number": "763-497-2367",
            "fax_number": "763-497-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12725 43RD ST NE",
            "address_2": "SUITE 202",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553764900",
            "telephone_number": "763-497-2367",
            "fax_number": "763-497-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FAMILY DENTAL CENTER TN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DESIMONE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-497-2367",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "8424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodene Lynn Nestande, PT
• Elena Thuy Nguyen
• Denis Fonyia Nkem, PHARM D
• Northway Academy, Inc.
• Northwest Family Counseling
• Northwest Spine and Pain Center of St. Michael, PA
• Hannah Elizabeth Noyes
• Abraham Nyei
• Ashley O'Konek
• Shem Oino

• General Practice Dentistry in Saint Michael, MN
• Providers in Saint Michael, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.