Active NPI
Nima Ibrahim Odowa, DDS
- Pediatric Dentistry
- Plymouth, MN
National Provider Identifier
1164086807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- D14186
- Practice address
- 2805 Campus Dr Ste 245
Plymouth, MN 55441-2678 - Phone
- (763) 383-1788
- NPI assigned
- Apr 29, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D14186 | MN | Primary |
Addresses
Primary practice location
2805 Campus Dr Ste 245
Plymouth, MN 55441-2678
Mailing address
2805 Campus Dr Ste 245
Plymouth, MN 55441-2678
Phone (763) 383-1788
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 |
|---|---|---|---|---|
| I20190617000476 | MN | Order and Referring Only - Dentist | 6901139484 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14186 | MN | MD | General Practice Dentistry |
| RES-30678 | IA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784505600000",
"number": "1164086807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 CAMPUS DR STE 245",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412678",
"telephone_number": "763-383-1788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 CAMPUS DR STE 245",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412678",
"telephone_number": "763-383-1788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOWA",
"first_name": "NIMA",
"middle_name": "IBRAHIM",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-29",
"last_updated": "2026-07-20",
"certification_date": "2026-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MN",
"license": "D14186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; 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.