A Gentle Dental Center of Rogers

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11666 Issued in MN

Legal business name

A GENTLE DENTAL CENTER OF ROGERS

Practice address

14115 James Rd
Suite 303
Rogers, MN 55374-9468

Phone

(763) 428-2226

Fax

(763) 428-3407

NPI assigned

Nov 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jill Pucel Koopman, D.D.S.

Title

Owner

Phone

(763) 428-2226

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jill Heather Pucel-Koopman, DDS

  • Dentist
  • Rogers, MN
  • NPI 1093704520
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124198635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14115 JAMES RD",
            "address_2": "SUITE 303",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749468",
            "telephone_number": "763-428-2226",
            "fax_number": "763-428-3407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14115 JAMES RD",
            "address_2": "SUITE 303",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749468",
            "telephone_number": "763-428-2226",
            "fax_number": "763-428-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A GENTLE DENTAL CENTER OF ROGERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOOPMAN",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "PUCEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-428-2226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Rogers, MN
• Providers in Rogers, 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.