First Avenue Dental, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11599 Issued in MN

Legal business name

FIRST AVENUE DENTAL, PA

Practice address

74 1St Ave SE
Little Falls, MN 56345-3042

Phone

(320) 632-8113

Fax

(320) 632-5584

NPI assigned

Dec 13, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Suzette A Olson, D.D.S.

Title

Dentist

Phone

(320) 632-8113

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205997152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 1ST AVE SE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453042",
            "telephone_number": "320-632-8113",
            "fax_number": "320-632-5584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 1ST AVE SE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453042",
            "telephone_number": "320-632-8113",
            "fax_number": "320-632-5584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST AVENUE DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "320-632-8113",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• FCSL Little Falls, LLC
• FCSL Little Falls, LLC
• Kristy L Feia
• Kelly Fenstermacher, O.D.
• First Avenue Dental PLLC
• Five Star Living of Little Falls, LLC
• Michael Douglas Forster, CRNA, DNAP
• Franciscan Sisters of Little Falls, Minnesota
• Alicia Anne Frankwitz, D.O.
• Fresenius Medical Care Centracare Dialysis, LLC

• All providers in Little Falls, MN
• General Practice Dentistry in Minnesota

• 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.