NPIMap

Organization Active NPI

Imagine Smiles

  • Dental Clinic/Center
  • Blaine, MN
National Provider Identifier
1174133698
Registry record updated Aug 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
IMAGINE SMILES
Practice address
10729 Town Square Drive NE
Suite 150
Blaine, MN 55449
Phone
(763) 269-8650
Fax
(763) 201-3377
NPI assigned
Aug 10, 2020
Last updated
Aug 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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

Authorized official

Name
Kelly Noye
Title
Financial Coordinator
Phone
(763) 269-8650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

10729 Town Square Drive NE
Suite 150
Blaine, MN 55449

Mailing address

10729 Town Square Drive NE
Suite 150
Blaine, MN 55449
Phone (763) 269-8650

National Provider Directory

National Provider Directory

Locations

10729 Town Square Dr NE
Ste 150
Blaine, MN 55449
Phone (763) 269-8650

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597017600000",
    "number": "1174133698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10729 TOWN SQUARE DRIVE NE",
            "address_2": "SUITE 150",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55449",
            "telephone_number": "763-269-8650",
            "fax_number": "763-201-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10729 TOWN SQUARE DRIVE NE",
            "address_2": "SUITE 150",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55449",
            "telephone_number": "763-269-8650",
            "fax_number": "763-201-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A",
        "authorized_official_last_name": "NOYE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "FINANCIAL COORDINATOR",
        "authorized_official_telephone_number": "763-269-8650"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.