NPIMap

Organization Active NPI

Main Street Dental Clinic of Mankato, PLLP

  • Dentist
  • Mankato, MN
National Provider Identifier
1285032243
Registry record updated Dec 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12942 Issued in MN
Legal business name
MAIN STREET DENTAL CLINIC OF MANKATO, PLLP
Practice address
287 St Andrews Drive
100
Mankato, MN 56001
Phone
(507) 720-0250
NPI assigned
Dec 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2014

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

Authorized official

Name
Dr. Chad Michael Hanson, DDSNPI 1073587366
Title
Cfo
Phone
(507) 583-2141

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12942 MN Primary

Addresses

Primary practice location

287 St Andrews Drive
100
Mankato, MN 56001

Mailing address

287 St Andrews Drive
100
Mankato, MN 56001-8584
Phone (507) 720-0250

National Provider Directory

National Provider Directory

Locations

287 Saint Andrews Dr
#100
Mankato, MN 56001
Phone (507) 720-0250

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1285032243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "287 ST ANDREWS DRIVE",
            "address_2": "100",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560018584",
            "telephone_number": "507-720-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "287 ST ANDREWS DRIVE",
            "address_2": "100",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-720-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL CLINIC OF MANKATO, PLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-08",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "507-583-2141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "12942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.