NPIMap

Organization Active NPI

Eagan Smiles Dentistry, PC

Doing business as Eagan Smiles Dentistry

  • General Practice Dentistry
  • Eagan, MN
National Provider Identifier
1184093551
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
EAGAN SMILES DENTISTRY, PC
Doing business as
Eagan Smiles Dentistry
Practice address
3405 Promenade Ave
Suite 300
Eagan, MN 55123-4404
Phone
(651) 236-7458
Fax
(651) 405-6995
NPI assigned
Sep 16, 2015
Last updated
Sep 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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

Authorized official

Name
Dr. Paul S Gebhart, DDS
Title
Owner
Phone
(651) 236-7458

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3405 Promenade Ave
Suite 300
Eagan, MN 55123-4404

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Eagan Smiles Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

3405 Promenade Ave
Ste 300
Eagan, MN 55123
Phone (651) 236-7458

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": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442361600000",
    "number": "1184093551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 PROMENADE AVE",
            "address_2": "SUITE 300",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551234404",
            "telephone_number": "651-236-7458",
            "fax_number": "651-405-6995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGAN SMILES DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-16",
        "last_updated": "2015-09-16",
        "status": "A",
        "authorized_official_last_name": "GEBHART",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-236-7458",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagan Smiles Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; 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.