Grand Avenue Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GRAND AVENUE DENTAL, LLC

Practice address

960 Grand Ave
Saint Paul, MN 55105-3014

Phone

(651) 291-9667

NPI assigned

Aug 18, 2020

Last updated

Aug 18, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert S Tyler

Title

Business Manager

Phone

(651) 291-9667

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul David Amble, DDS

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1356439160
  NPD
• Megan Pint, D.D.S.

  • Dentist
  • Saint Paul, MN
  • NPI 1326454083
  NPD (past)

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1154933661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551053014",
            "telephone_number": "651-291-9667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551053014",
            "telephone_number": "651-291-9667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND AVENUE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "651-291-9667"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Graff
• Norman Walter Graff Jr., CRNA
• Timothy Joseph Graff, D.C.
• Matthew Gram, OTR/L
• Grand Avenue Chiropractic & Acupuncture, PLLC
• Grand Avenue Smiles
• Grand Dental Care, PLLC (Grand Avenue Dental, LLC)
• Grand Ethnic Minnesota Home Care LLC
• Grand Health Chiropractic and Wellness Center, P.a.
• Grand Spectacle Inc

• Dental Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, 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 Aug 18, 2020; 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.