Active NPI
Brent Alan Cataldo
- Dentist
- Plymouth, MN
National Provider Identifier
1295923423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D11411
- Practice address
- 10100 6TH Ave N
Ste 102 B
Plymouth, MN 55441-6535 - Phone
- (763) 544-7856
- Fax
- (763) 544-8056
- NPI assigned
- Oct 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | D11411 | MN | Primary |
Addresses
Primary practice location
10100 6TH Ave N
Ste 102 B
Plymouth, MN 55441-6535
Mailing address
10100 6TH Ave N
Ste 102 B
Plymouth, MN 55441-6535
Phone (763) 544-7856
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 151252800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160303000118 | MN | Order and Referring Only - Other (Physician) | 9537344924 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292803200000",
"number": "1295923423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10100 6TH AVE N",
"address_2": "STE 102 B",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554416535",
"telephone_number": "763-544-7856",
"fax_number": "763-544-8056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10100 6TH AVE N",
"address_2": "STE 102 B",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554416535",
"telephone_number": "763-544-7856",
"fax_number": "763-544-8056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CATALDO",
"first_name": "BRENT",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-12",
"last_updated": "2010-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D11411",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151252800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.