Active NPI
Tina A Nguyen
- Dentist
- Coon Rapids, MN
National Provider Identifier
1124536859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D13919
- Practice address
- 13040 Riverdale Dr NW Ste 600
Coon Rapids, MN 55448-8419 - Phone
- (763) 323-3042
- NPI assigned
- Jan 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D13919 | MN | Primary |
Addresses
Primary practice location
13040 Riverdale Dr NW Ste 600
Coon Rapids, MN 55448-8419
Mailing address
8024 Pleasant View Dr NE
Spring Lake Park, MN 55432-2113
Phone (763) 742-6537
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180409001997 | MN | Order and Referring Only - Dentist | 3173886983 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13919 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northland Dental Partners, PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Coon Rapids, MN
- NPI 1740938166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516060800000",
"number": "1124536859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8024 PLEASANT VIEW DR NE",
"city": "SPRING LAKE PARK",
"state": "MN",
"postal_code": "554322113",
"telephone_number": "763-742-6537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13040 RIVERDALE DR NW STE 600",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554488419",
"telephone_number": "763-323-3042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "TINA",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-16",
"last_updated": "2018-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D13919",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.