NPIMap

Organization Active NPI

Eversmiles Pediatric Dentistry, PLLC

  • Pediatric Dentistry
  • Hermantown, MN
National Provider Identifier
1285873687
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
EVERSMILES PEDIATRIC DENTISTRY, PLLC
Practice address
4419 Air Base Road
Hermantown, MN 55811-1847
Phone
(218) 728-2117
Fax
(218) 728-2700
NPI assigned
Feb 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Authorized official

Name
Dr. John Patrick Conry, BDSMSNPI 1205958931
Title
Partner
Phone
(218) 728-2117

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

4419 Air Base Road
Hermantown, MN 55811-1847

Mailing address

4419 Air Base Road
Hermantown, MN 55811-1847
Phone (218) 728-2117

Other names 1

  • Duluth Pediatric Dentistry, PLLC Former legal business name

National Provider Directory

National Provider Directory

Locations

4419 Air Base Rd
Hermantown, MN 55811
Phone (218) 728-2117

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": "1234224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1285873687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4419 AIR BASE ROAD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111847",
            "telephone_number": "218-728-2117",
            "fax_number": "218-728-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4419 AIR BASE ROAD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111847",
            "telephone_number": "218-728-2117",
            "fax_number": "218-728-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERSMILES PEDIATRIC DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-10",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "CONRY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "218-728-2117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "BDSMS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duluth Pediatric Dentistry, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Hermantown, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.