NPIMap

Organization Active NPI

Interlachen Dental Associates

  • General Practice Dentistry
  • Edina, MN
National Provider Identifier
1174600621
Registry record updated Jan 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
INTERLACHEN DENTAL ASSOCIATES
Practice address
5101 Vernon Avenue
Suite 1B
Edina, MN 55436
Phone
(952) 920-9579
Fax
(952) 920-9298
NPI assigned
Nov 1, 2006
Last updated
Jan 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2012

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

Authorized official

Name
Dr. Michael John Gitzen, DDSNPI 1770534547
Title
President Owner Doctor
Phone
(952) 920-9579

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 Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

5101 Vernon Avenue
Suite 1B
Edina, MN 55436

Mailing address

5101 Vernon Avenue
Suite 1B
Edina, MN 55436
Phone (952) 920-9579

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326326400000",
    "number": "1174600621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 VERNON AVENUE",
            "address_2": "SUITE 1B",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55436",
            "telephone_number": "952-920-9579",
            "fax_number": "952-920-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 VERNON AVENUE",
            "address_2": "SUITE 1B",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55436",
            "telephone_number": "952-920-9579",
            "fax_number": "952-920-9298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERLACHEN DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-01-12",
        "status": "A",
        "authorized_official_last_name": "GITZEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT OWNER DOCTOR",
        "authorized_official_telephone_number": "952-920-9579",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; 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.