NPIMap

Organization Active NPI

Professional Drive Dental Group P.a.

  • General Practice Dentistry
  • Northfield, MN
National Provider Identifier
1164446282
Registry record updated Oct 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PROFESSIONAL DRIVE DENTAL GROUP P.A.
Practice address
600 Professional Dr
Northfield, MN 55057-2755
Phone
(507) 645-5264
Fax
(507) 663-0303
NPI assigned
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2013

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

Authorized official

Name
Jerome L Appeldoorn, D.D.S.NPI 1154345247
Title
President
Phone
(507) 645-5264

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

600 Professional Dr
Northfield, MN 55057-2755

Mailing address

600 Professional Dr
Northfield, MN 55057-2755
Phone (507) 645-5264

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1164446282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PROFESSIONAL DR",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572755",
            "telephone_number": "507-645-5264",
            "fax_number": "507-663-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PROFESSIONAL DR",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572755",
            "telephone_number": "507-645-5264",
            "fax_number": "507-663-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DRIVE DENTAL GROUP P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "APPELDOORN",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "507-645-5264",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northfield, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; 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.