Mustapha Mansuri

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14543 Issued in MN

Practice address

8454 Highway 7
St Louis Park, MN 55426-3900

Phone

(952) 933-3667

NPI assigned

Apr 8, 2021

Last updated

Aug 8, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Knollwood Dentistry, PC

  dba Knollwood Dentistry

  • General Practice Dentistry
  • St Louis Park, MN
  • NPI 1497149496
  NPD (past)

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

{
    "created_epoch": "1617840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1215516919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12816 FRAIZER ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554493505",
            "telephone_number": "651-529-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8454 HIGHWAY 7",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263900",
            "telephone_number": "952-933-3667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSURI",
        "first_name": "MUSTAPHA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ajaydas Thalappil Manikkan, MD, MPH
• Cynthia Ann Manning-Recker, MA MFT
• Carol Manning III
• Lynn Manning
• Lainey C Mannix, MSW, LICSW
• Joan Marie Marcuson, MA, LMFT
• Alexandra Paige Mareck, CNP
• Margaret Stearns, LLC
• Marie Casey Olseth, MD, LLC (West End Consultation Group)
• Josephine Grace Marino, AUD

• General Practice Dentistry in St Louis Park, MN
• Providers in St Louis Park, 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 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.