Individual provider Active NPI

Stephen Joseph Tervola, DDS

  • General Practice Dentistry
  • Minneapolis, MN
National Provider Identifier
1265493159
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D8686 Issued in MN
Practice address
3624 E Lake St
Minneapolis, MN 55406-2152
Phone
(612) 729-2361
Fax
(612) 729-2362
NPI assigned
Mar 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D8686 MN Primary

Addresses

Primary practice location

3624 E Lake St
Minneapolis, MN 55406-2152

Mailing address

1172 Aquarius LN
Eagan, MN 55123-1824
Phone (651) 683-9497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D8686MNMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1265493159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 AQUARIUS LN",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231824",
            "telephone_number": "651-683-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062152",
            "telephone_number": "612-729-2361",
            "fax_number": "612-729-2362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERVOLA",
        "first_name": "STEPHEN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D8686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.