Amana Dental Corp. – General Practice Dentistry

Key facts

NPI: 1275770596
Entity type: Organization (NPI type 2)
Primary specialty: General Practice Dentistry 1223G0001X
License: D 11855 (MN)
Legal business name: AMANA DENTAL CORP.
Practice address: 2326 Central Ave NE
Minneapolis, MN 55418-3710
Phone: (612) 789-2928
Fax: (612) 789-2783
NPI assigned: Jan 8, 2009
Organization subpart: No

Authorized official

Name: Dr. Mazen Manla, DDS
Title: Presedent
Phone: (312) 451-4050

National Provider Directory

Locations

2326 Central Ave NE
Minneapolis, MN 55418
Phone (612) 789-2928

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry Group: 193200000X MULTI-SPECIALTY GROUP	1223G0001X	D 11855	MN	Yes

Addresses

Primary practice location

2326 Central Ave NE
Minneapolis, MN 55418-3710

Mailing address

2326 Central Ave NE
Minneapolis, MN 55418-3710
Phone (612) 789-2928

Other identifiers

Identifier	Type	State	Issuer
330405100	Medicaid	MN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 8, 2009.

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1275770596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2326 CENTRAL AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183710",
            "telephone_number": "612-789-2928",
            "fax_number": "612-789-2783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2326 CENTRAL AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183710",
            "telephone_number": "612-789-2928",
            "fax_number": "612-789-2783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANA DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-08",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "MANLA",
        "authorized_official_first_name": "MAZEN",
        "authorized_official_title_or_position": "PRESEDENT",
        "authorized_official_telephone_number": "312-451-4050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D 11855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330405100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

All providers in Minneapolis, MN · General Practice Dentistry in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.