Active NPI
Linda M Maytan, DDS
- Student in an Organized Health Care Education/Training Program
- Faribault, MN
National Provider Identifier
1295867562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 21230
- Practice address
- 400 4TH St NW
Suite A3A
Faribault, MN 55021-5031 - Phone
- (507) 384-6830
- Fax
- (651) 431-5575
- NPI assigned
- Mar 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11380 | MN | |
| Dentist | 122300000X | 21230 | MA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 21230 | MA | Primary |
Addresses
Primary practice location
400 4TH St NW
Suite A3A
Faribault, MN 55021-5031
Mailing address
400 4TH St NW
Southern Cities Clinic
Faribault, MN 55021-5031
Phone (507) 384-6830
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 |
|---|---|---|---|
| 21230 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Cities Clinic | Past | Accepting new patients | |
| Southern Cities Community Clinic | Dentist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Physician
- Faribault, MN
- NPI 1437218740
-
- Dentist
- Faribault, MN
- NPI 1730630393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440633600000",
"number": "1295867562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 4TH ST NW",
"address_2": "SOUTHERN CITIES CLINIC",
"city": "FARIBAULT",
"state": "MN",
"postal_code": "550215031",
"telephone_number": "507-384-6830",
"fax_number": "651-431-5575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 4TH ST NW",
"address_2": "SUITE A3A",
"city": "FARIBAULT",
"state": "MN",
"postal_code": "550215031",
"telephone_number": "507-384-6830",
"fax_number": "651-431-5575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYTAN",
"first_name": "LINDA",
"middle_name": "M",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-12",
"last_updated": "2015-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "11380",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "21230",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": "21230",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Faribault, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.