Minnesota Dental Implant Center

Primary specialty

DentistTaxonomy code 122300000X

License

D8779 Issued in MN

Legal business name

MINNESOTA DENTAL IMPLANT CENTER

Practice address

8325 Wayzata Blvd Ste 150
Golden Valley, MN 55426-1398

Phone

(763) 417-9975

Fax

(763) 417-9976

NPI assigned

Feb 22, 2012

Organization subpart

No

Name

Ms. Christina Moody

Title

Office Manager

Phone

(605) 716-5622

Locations

• The Dental Implant Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 22, 2012.

{
    "created_epoch": "1329868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1316210347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8325 WAYZATA BLVD STE 150",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261398",
            "telephone_number": "763-417-9975",
            "fax_number": "763-417-9976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8325 WAYZATA BLVD STE 150",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261398",
            "telephone_number": "763-417-9975",
            "fax_number": "763-417-9976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA DENTAL IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-22",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "605-716-5622",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D8779",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12070",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dental Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gerald G Mindrum, M.D.
• Minneapolis Clinic of Neurology, LTD
• Minneapolis Health Clinic PLLC
• Minneapolis Ophthalmology ASC LLC
• Minnesota Behavioral Resources LLC
• Minnesota Emergency Communications Team
• Minnesota Medical Imaging, LLC
• Minnesota Medical Imaging, LLC
• Minnesota Medical Services PLLC
• Sanjay K Mishra, MD

• All providers in Golden Valley, MN
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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.