Active NPI
William Gavin, D.D.S.
- Endodontics
- Woodbury, MN
National Provider Identifier
1295856763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 7305
- Practice address
- 6949 Valley Creek Rd
#130
Woodbury, MN 55125-2253 - Phone
- (651) 731-1630
- Fax
- (651) 731-1635
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 7305 | MN | Primary |
Addresses
Primary practice location
6949 Valley Creek Rd
#130
Woodbury, MN 55125-2253
Mailing address
6949 Valley Creek Rd
#130
Woodbury, MN 55125-2253
Phone (651) 732-1630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7305 | MN | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Endodontics, P.a. | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Endodontics
- Woodbury, MN
- NPI 1205957776
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295856763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6949 VALLEY CREEK RD",
"address_2": "#130",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252253",
"telephone_number": "651-732-1630",
"fax_number": "651-731-1635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6949 VALLEY CREEK RD",
"address_2": "#130",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252253",
"telephone_number": "651-731-1630",
"fax_number": "651-731-1635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MN",
"license": "7305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.