Southern Minnesota Periodontics PA

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

SOUTHERN MINNESOTA PERIODONTICS PA

Practice address

99 Navaho Ave
Suite #102
Mankato, MN 56001-4876

Phone

(507) 345-7537

Fax

(507) 345-7538

NPI assigned

Jul 21, 2016

Last updated

Jul 22, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sergey Borisovich Dolgov

Title

Owner

Phone

(786) 487-1190

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1469059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469145600000",
    "number": "1316390669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 NAVAHO AVE",
            "address_2": "SUITE #102",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014876",
            "telephone_number": "507-345-7537",
            "fax_number": "507-345-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 NAVAHO AVE",
            "address_2": "SUITE #102",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014876",
            "telephone_number": "507-345-7537",
            "fax_number": "507-345-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MINNESOTA PERIODONTICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-21",
        "last_updated": "2016-07-22",
        "status": "A",
        "authorized_official_last_name": "DOLGOV",
        "authorized_official_first_name": "SERGEY",
        "authorized_official_middle_name": "BORISOVICH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-487-1190",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Mankato, MN
• Providers in Mankato, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; 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.