NPIMap

Organization Active NPI

Metropolitan Pediatric Dental Associates, LTD

  • Pediatric Dentistry
  • Saint Paul, MN
National Provider Identifier
1245389246
Registry record updated May 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD
Practice address
1021 Bandana Blvd E
Suite 121
Saint Paul, MN 55108-5113
Phone
(651) 224-4969
Fax
(651) 223-8047
NPI assigned
Jan 9, 2007
Organization subpart
Yes
Parent organization
METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2015

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

Authorized official

Name
James D Nickman, DDS
Title
President
Phone
(651) 224-4969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1021 Bandana Blvd E
Suite 121
Saint Paul, MN 55108-5113

Mailing address

1021 Bandana Blvd E
Suite 121
Saint Paul, MN 55108-5113
Phone (651) 224-4969

Other identifiers 1

IdentifierTypeStateIssuer
518322700MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Metropolitan Pediatric Dental Associates LTD5 organizations share this tax ID, including this one
Part of
Metropolitan Pediatric Dental Associates LTD

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1021 Bandana Blvd E
Ste 121
Saint Paul, MN 55108
Phone (651) 224-4969

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431561600000",
    "number": "1245389246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 BANDANA BLVD E",
            "address_2": "SUITE 121",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085113",
            "telephone_number": "651-224-4969",
            "fax_number": "651-223-8047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 BANDANA BLVD E",
            "address_2": "SUITE 121",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085113",
            "telephone_number": "651-224-4969",
            "fax_number": "651-223-8047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD",
        "enumeration_date": "2007-01-09",
        "last_updated": "2015-05-14",
        "status": "A",
        "authorized_official_last_name": "NICKMAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-224-4969",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518322700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; 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.