Inside Edge Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

INSIDE EDGE DENTAL PLLC

Practice address

1346 Payne Ave
Saint Paul, MN 55130-3434

Phone

(651) 774-6085

Fax

(651) 774-2660

NPI assigned

Apr 16, 2013

Organization subpart

No

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

Authorized official

Name

Jennifer A Marker Johnson, DDSNPI 1982673570

Title

DDS/President

Phone

(651) 774-6085

Specialties & licenses 1

Addresses

Other names 1

• East Dental Doing business as

Practitioners 2

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

• Jennifer Ann Marker Johnson, D.D.S.

  • Dentist
  • Saint Paul, MN
  • NPI 1982673570

  General Practice

  NPD (past) Authorized official
• Douglas Glen Walesheck, D.D.S.

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1043295132
  NPD (past)

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485993600000",
    "number": "1114360492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1346 PAYNE AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551303434",
            "telephone_number": "651-774-6085",
            "fax_number": "651-774-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 PAYNE AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551303434",
            "telephone_number": "651-774-6085",
            "fax_number": "651-774-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSIDE EDGE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-16",
        "last_updated": "2017-02-02",
        "status": "A",
        "authorized_official_last_name": "MARKER JOHNSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DDS/PRESIDENT",
        "authorized_official_telephone_number": "651-774-6085",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Saint Paul, MN
• Providers in Saint Paul, 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 Feb 2, 2017; 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.