Como Park Dentistry PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

COMO PARK DENTISTRY PA

Practice address

1132 Larpenteur Ave W
Saint Paul, MN 55113-6317

Phone

(507) 272-5955

NPI assigned

Aug 10, 2022

Organization subpart

No

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

Authorized official

Name

Derrik Hartman, DDSNPI 1659711299

Title

President

Phone

(507) 272-5955

Specialties & licenses 1

Addresses

Other names 1

• Como Park Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derrik Hartman

  • Dentist
  • Saint Paul, MN
  • NPI 1659711299
  NPD Authorized official

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1194453951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 LARPENTEUR AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551136317",
            "telephone_number": "507-272-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 LARPENTEUR AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551136317",
            "telephone_number": "507-272-5955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMO PARK DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-10",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "HARTMAN",
        "authorized_official_first_name": "DERRIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "507-272-5955",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Como Park Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.