Matthew P Dale DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10980 Issued in MN

Legal business name

MATTHEW P DALE DDS PA

Practice address

13998 Maple Knoll Way # Ll103
Maple Grove, MN 55369-7004

Phone

(763) 425-2072

Fax

(763) 425-1487

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Patrick Dale, DDS

Title

President

Phone

(763) 245-2072

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1124230800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13998 MAPLE KNOLL WAY # LL103",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697004",
            "telephone_number": "763-425-2072",
            "fax_number": "763-425-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13998 MAPLE KNOLL WAY # LL103",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697004",
            "telephone_number": "763-425-2072",
            "fax_number": "763-425-1487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW P DALE DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "DALE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-245-2072",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Maple Grove, MN
• Providers in Maple Grove, 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 13, 2014; 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.