Northwoods Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10011 Issued in MN

Legal business name

NORTHWOODS DENTAL

Practice address

15600 36TH Ave N
Suite 270
Plymouth, MN 55446-3369

Phone

(763) 557-0911

Fax

(763) 557-5157

NPI assigned

Jan 25, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Pamela J Kent

Title

Office Manager

Phone

(763) 557-0911

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215083183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15600 36TH AVE N",
            "address_2": "SUITE 270",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463369",
            "telephone_number": "763-557-0911",
            "fax_number": "763-557-5157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15600 36TH AVE N",
            "address_2": "SUITE 270",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463369",
            "telephone_number": "763-557-0911",
            "fax_number": "763-557-5157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWOODS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KENT",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "763-557-0911",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Plymouth, 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.