NPIMap

Organization Active NPI

Javan Dental Inc.

Doing business as Eagle Valley Dental

  • Dentist
  • Woodbury, MN
National Provider Identifier
1245250596
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
L11291 Issued in MN
Legal business name
JAVAN DENTAL INC.
Doing business as
Eagle Valley Dental
Practice address
683 Bielenberg Dr
Suite 205
Woodbury, MN 55125-1705
Phone
(651) 200-4747
Fax
(651) 998-1009
NPI assigned
Jul 20, 2006
Last updated
Feb 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Authorized official

Name
Dr. Marjan Javanmardian, D.D.S.NPI 1538189824
Title
Dentist/Owner
Phone
(651) 200-4747

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X L11291 MN Primary

Addresses

Primary practice location

683 Bielenberg Dr
Suite 205
Woodbury, MN 55125-1705

Mailing address

683 Bielenberg Dr
Suite 205
Woodbury, MN 55125-1705
Phone (651) 200-4747

Other names 1

  • Eagle Valley Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486425600000",
    "number": "1245250596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "683 BIELENBERG DR",
            "address_2": "SUITE 205",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251705",
            "telephone_number": "651-200-4747",
            "fax_number": "651-998-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "683 BIELENBERG DR",
            "address_2": "SUITE 205",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251705",
            "telephone_number": "651-200-4747",
            "fax_number": "651-998-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAVAN DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2017-02-07",
        "status": "A",
        "authorized_official_last_name": "JAVANMARDIAN",
        "authorized_official_first_name": "MARJAN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "651-200-4747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "L11291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Valley Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; 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.