Jeffrey Ross Remakel, D.D.S
Individual provider Active NPI Dentist · St Louis Park, MN
NPI 1194012385 · NPPES record last updated Sep 12, 2012
Key facts
- NPI
- 1194012385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D12954 (MN)
- Practice address
- 5000 W 36TH St Ste 250
St Louis Park, MN 55416-2776 - Phone
- (952) 920-3700
- NPI assigned
- Jul 7, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12954 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Specialists of Minnesota, PLLC | Past | Accepting new patients | |
| PDG, P.a. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D12954 | MN | Yes |
Addresses
Primary practice location
5000 W 36TH St Ste 250
St Louis Park, MN 55416-2776
Mailing address
5000 W 36TH St Ste 250
St Louis Park, MN 55416-2776
Phone (952) 920-3700
Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.