NPIMap

Organization Active NPI

Modern Dental Professionals Minnesota PC

Doing business as Midwest Dental - White Bear Lake

  • General Practice Dentistry
  • Saint Paul, MN
National Provider Identifier
1295238178
Registry record updated Mar 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS MINNESOTA PC
Doing business as
Midwest Dental - White Bear Lake
Practice address
4520 Centerville Rd
Saint Paul, MN 55127-3602
Phone
(651) 426-4799
Fax
(651) 426-8106
NPI assigned
Mar 16, 2018
Last updated
Mar 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2018

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

Authorized official

Name
Chad Hendricks
Title
Director, Payer Strategy
Phone
(612) 351-6876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X MN Primary

Addresses

Primary practice location

4520 Centerville Rd
Saint Paul, MN 55127-3602

Mailing address

680 Hehli Way
Mondovi, WI 54755-1639
Phone (715) 598-2311

Other names 1

  • Midwest Dental - White Bear Lake Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Midwest Dental39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521158400000",
    "number": "1295238178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 HEHLI WAY",
            "city": "MONDOVI",
            "state": "WI",
            "postal_code": "547551639",
            "telephone_number": "715-598-2311",
            "fax_number": "715-350-6855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 CENTERVILLE RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551273602",
            "telephone_number": "651-426-4799",
            "fax_number": "651-426-8106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS MINNESOTA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-03-16",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "DIRECTOR, PAYER STRATEGY",
        "authorized_official_telephone_number": "612-351-6876"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental - White Bear Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2018; 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.