Scandia Family Dental PA

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SCANDIA FAMILY DENTAL PA

Practice address

21080 Olinda Trail N
Scandia, MN 55073

Phone

(651) 433-2655

Fax

(651) 433-2655

NPI assigned

Dec 12, 2006

Organization subpart

No

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

Authorized official

Name

Michele Marie Revoir, DDS

Title

Dentist

Phone

(651) 433-2655

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194886630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21080 OLINDA TRAIL N",
            "city": "SCANDIA",
            "state": "MN",
            "postal_code": "55073",
            "telephone_number": "651-433-2655",
            "fax_number": "651-433-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21080 OLINDA TRAIL N",
            "city": "SCANDIA",
            "state": "MN",
            "postal_code": "55073",
            "telephone_number": "651-433-2655",
            "fax_number": "651-433-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCANDIA FAMILY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REVOIR",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "651-433-2655",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.