NPIMap

Organization Active NPI

Minnesota Dental Professionals, P.C.

  • General Practice Dentistry
  • Albertville, MN
National Provider Identifier
1144064700
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MINNESOTA DENTAL PROFESSIONALS, P.C.
Practice address
5047 Jason Ave NE
Albertville, MN 55301-9688
Phone
(763) 497-8165
NPI assigned
Jun 19, 2024
Organization subpart
Yes
Parent organization
MINNESOTA DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

5047 Jason Ave NE
Albertville, MN 55301-9688

Mailing address

5047 Jason Ave NE
Albertville, MN 55301-9688
Phone (763) 497-8165

Other names 1

  • Albertville Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Dental Professionals PC23 organizations share this tax ID, including this one
Part of
Minnesota Dental Professionals PC

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1144064700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5047 JASON AVE NE",
            "city": "ALBERTVILLE",
            "state": "MN",
            "postal_code": "553019688",
            "telephone_number": "763-497-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5047 JASON AVE NE",
            "city": "ALBERTVILLE",
            "state": "MN",
            "postal_code": "553019688",
            "telephone_number": "763-497-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2024-06-19",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Albertville Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albertville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.