Artisan Dental. P.a.

Primary specialty

DentistTaxonomy code 122300000X

License

D11984 Issued in MN

Legal business name

ARTISAN DENTAL. P.A.

Practice address

4000 Annapolis LN Suite 103.
Plymouth, MN 55667

Phone

(763) 519-8880

Fax

(763) 519-8881

NPI assigned

Aug 22, 2014

Organization subpart

No

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

Authorized official

Name

Kamal Ahmed, BDS.

Title

President

Phone

(763) 519-8880

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1408665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1245639517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000-ANNAPOLIS LN. SUITE 103.",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55667",
            "telephone_number": "763-519-8880",
            "fax_number": "763-519-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 ANNAPOLIS LN SUITE 103.",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55667",
            "telephone_number": "763-519-8880",
            "fax_number": "763-519-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARTISAN DENTAL. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-22",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "KAMAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-519-8880",
        "authorized_official_credential": "BDS."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11984",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "58780",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; 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.