Long Lake Family Denistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10256 Issued in MN

Legal business name

LONG LAKE FAMILY DENISTRY

Practice address

991 9TH Ave NW
New Brighton, MN 55112-2665

Phone

(651) 633-1311

Fax

(651) 633-4339

NPI assigned

Apr 27, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Hossein A Jalali, DDSNPI 1417932773

Title

Owner

Phone

(651) 633-1311

Specialties & licenses 3

Addresses

Locations

Practitioners 1

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

• Hossein A Jalali, D.D.S

  • Dentist
  • New Brighton, MN
  • NPI 1417932773
  NPD (past) Authorized official

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461715200000",
    "number": "1134574163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 9TH AVE NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551122665",
            "telephone_number": "651-633-1311",
            "fax_number": "651-633-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 9TH AVE NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551122665",
            "telephone_number": "651-633-1311",
            "fax_number": "651-633-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG LAKE FAMILY DENISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A",
        "authorized_official_last_name": "JALALI",
        "authorized_official_first_name": "HOSSEIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-633-1311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10256",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13480",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "10465",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in New Brighton, MN
• Providers in New Brighton, 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 Apr 27, 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.