Individual provider Active NPI

Anupam M Gatecha, BDS

  • General Practice Dentistry
  • Brooklyn Park, MN
National Provider Identifier
1164601324
Registry record updated Dec 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D12203 Issued in MN
Practice address
8511 Jefferson LN N
Brooklyn Park, MN 55445-2121
Phone
(763) 205-0526
Fax
(763) 205-0527
NPI assigned
Oct 24, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D12203 MN Primary

Addresses

Primary practice location

8511 Jefferson LN N
Brooklyn Park, MN 55445-2121

Mailing address

8511 Jefferson LN N
Brooklyn Park, MN 55445-2121
Phone (763) 205-0526

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151202001704 MN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2961702659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418860800000",
    "number": "1164601324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8511 JEFFERSON LN N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452121",
            "telephone_number": "763-205-0526",
            "fax_number": "763-205-0527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8511 JEFFERSON LN N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452121",
            "telephone_number": "763-205-0526",
            "fax_number": "763-205-0527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATECHA",
        "first_name": "ANUPAM",
        "middle_name": "M",
        "credential": "BDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-24",
        "last_updated": "2014-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

Verify at the official NPI Registry.