NPIMap

Organization Active NPI

Family Periodontic Specialists, PLC

  • Periodontics
  • Saint Paul, MN
National Provider Identifier
1194474593
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
FAMILY PERIODONTIC SPECIALISTS, PLC
Practice address
1375 Saint Anthony Ave
Saint Paul, MN 55104-4006
Phone
(651) 645-4671
Fax
(651) 646-1342
NPI assigned
Mar 22, 2022
Organization subpart
Yes
Parent organization
FAMILY PERIODONTIC SPECIALISTS, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

1375 Saint Anthony Ave
Saint Paul, MN 55104-4006

Mailing address

1375 Saint Anthony Ave
Saint Paul, MN 55104-4006
Phone (651) 645-4671

Other names 1

  • Metro Dentalcare St. Paul Midway - Periodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family Periodontic Specialists PLC4 organizations share this tax ID, including this one
Part of
Family Periodontic Specialists PLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1194474593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 SAINT ANTHONY AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044006",
            "telephone_number": "651-645-4671",
            "fax_number": "651-646-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 SAINT ANTHONY AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044006",
            "telephone_number": "651-645-4671",
            "fax_number": "651-646-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PERIODONTIC SPECIALISTS, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY PERIODONTIC SPECIALISTS, PLC",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metro Dentalcare St. Paul Midway - Periodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.