NPIMap

Organization Active NPI

Modern Dental Professionals Minnesota PC

Doing business as Midwest Dental

  • General Practice Dentistry
  • Eagan, MN
National Provider Identifier
1255639696
Registry record updated Mar 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS MINNESOTA PC
Doing business as
Midwest Dental
Practice address
1121 Town Centre Dr
#200
Eagan, MN 55123-1199
Phone
(651) 454-4771
Fax
(651) 406-9298
NPI assigned
Mar 9, 2011
Last updated
Mar 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2011

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

Authorized official

Name
James Myer
Title
Cfo
Phone
(715) 926-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X MN Primary

Addresses

Primary practice location

1121 Town Centre Dr
#200
Eagan, MN 55123-1199

Mailing address

1121 Town Centre Dr
#200
Eagan, MN 55123-1199
Phone (651) 454-4771

Other names 1

  • Midwest Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Midwest Dental39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Practitioners & affiliated clinicians

Practitioners 7

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": "1299628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1255639696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 TOWN CENTRE DR",
            "address_2": "#200",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231199",
            "telephone_number": "651-454-4771",
            "fax_number": "651-406-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 TOWN CENTRE DR",
            "address_2": "#200",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231199",
            "telephone_number": "651-454-4771",
            "fax_number": "651-406-9298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS MINNESOTA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-09",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "MYER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "715-926-5050"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; 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.