NPIMap

Organization Active NPI

Groveland Dental P.a.

  • Dental Clinic/Center
  • Saint Paul, MN
National Provider Identifier
1306130430
Registry record updated Jun 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
11657 Issued in MN
Legal business name
GROVELAND DENTAL P.A.
Practice address
2042 Saint Clair Ave
Saint Paul, MN 55105-1650
Phone
(651) 298-0024
Fax
(651) 695-2333
NPI assigned
Jun 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2011

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

Authorized official

Name
Dr. Matthew Colaizy
Title
President
Phone
(651) 298-0024

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 11657 MN Primary

Addresses

Primary practice location

2042 Saint Clair Ave
Saint Paul, MN 55105-1650

Mailing address

2042 Saint Clair Ave
Saint Paul, MN 55105-1650
Phone (651) 298-0024

National Provider Directory

National Provider Directory

Locations

2042 Saint Clair Ave
Saint Paul, MN 55105
Phone (651) 298-0024

NPI Registry JSON

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307404800000",
    "number": "1306130430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2042 SAINT CLAIR AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051650",
            "telephone_number": "651-298-0024",
            "fax_number": "651-695-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2042 SAINT CLAIR AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051650",
            "telephone_number": "651-298-0024",
            "fax_number": "651-695-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROVELAND DENTAL P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-07",
        "last_updated": "2011-06-07",
        "status": "A",
        "authorized_official_last_name": "COLAIZY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-298-0024",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "11657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 7, 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.