Active NPI
Shay Mieczkowski, DDS
- Dentist
- Minneapolis, MN
National Provider Identifier
1316515349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14549
- Practice address
- 515 Delaware St SE
Minneapolis, MN 55455-0357 - Phone
- (612) 625-0402
- NPI assigned
- Jun 15, 2021
- Sex
- Male
- Sole proprietor
- No
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 | D14549 | MN | Primary |
Addresses
Primary practice location
515 Delaware St SE
Minneapolis, MN 55455-0357
Mailing address
1019 29TH Ave SE Apt E
Minneapolis, MN 55414-2762
Phone (612) 810-5166
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 |
|---|---|---|---|
| D14549 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1316515349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 29TH AVE SE APT E",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554142762",
"telephone_number": "612-810-5166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 DELAWARE ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550357",
"telephone_number": "612-625-0402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIECZKOWSKI",
"first_name": "SHAY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-15",
"last_updated": "2021-06-15",
"certification_date": "2021-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.