Minnesota Dental Surgery PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D12540 Issued in MN

Legal business name

MINNESOTA DENTAL SURGERY PLLC

Practice address

9801 Dupont Ave S
Bloomington, MN 55431-3100

Phone

(952) 215-7419

NPI assigned

Jun 15, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Bennett Isabella, DDS

Title

Ceo

Phone

(952) 215-7419

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1124478607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 120TH ST W",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "550683501",
            "telephone_number": "952-215-7419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313100",
            "telephone_number": "952-215-7419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA DENTAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "ISABELLA",
        "authorized_official_first_name": "BENNETT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-215-7419",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D12540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.