Geetha J Damodaran, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D10949 Issued in MN

Practice address

4641 White Bear Pkwy
White Bear Lake, MN 55110-3300

Phone

(651) 429-0404

Fax

(651) 429-0742

NPI assigned

Apr 5, 2010

Last updated

Aug 9, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Birch Lake Dental

  • Dental Clinic/Center
  • White Bear Lake, MN
  • NPI 1922619162
  NPD Authorized official
• Birch Lake Dental PA

  • General Practice Dentistry
  • White Bear Lake, MN
  • NPI 1083853113
  Authorized official Same address or phone

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

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596931200000",
    "number": "1275858078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103300",
            "telephone_number": "651-429-0404",
            "fax_number": "651-429-0742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103300",
            "telephone_number": "651-429-0404",
            "fax_number": "651-429-0742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMODARAN",
        "first_name": "GEETHA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-05",
        "last_updated": "2020-08-09",
        "certification_date": "2020-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shelly Darr
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• Dentist in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2020; 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.