NPIMap

Organization Active NPI

Molldrem Family Dentistry

  • General Practice Dentistry
  • Eden Prairie, MN
National Provider Identifier
1326173279
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11329 Issued in MN
Legal business name
MOLLDREM FAMILY DENTISTRY
Practice address
800 Prairie Center Dr
Suite 250
Eden Prairie, MN 55344-7328
Phone
(952) 974-5116
Fax
(952) 903-0012
NPI assigned
Feb 22, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kevin Daniel Molldrem, DDSNPI 1740404797
Title
Owner
Phone
(952) 974-5116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 11329 MN Primary

Addresses

Primary practice location

800 Prairie Center Dr
Suite 250
Eden Prairie, MN 55344-7328

Mailing address

800 Prairie Center Dr
Suite 250
Eden Prairie, MN 55344-7328
Phone (952) 974-5116

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326173279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 PRAIRIE CENTER DR",
            "address_2": "SUITE 250",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447328",
            "telephone_number": "952-974-5116",
            "fax_number": "952-903-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PRAIRIE CENTER DR",
            "address_2": "SUITE 250",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447328",
            "telephone_number": "952-974-5116",
            "fax_number": "952-903-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLLDREM FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOLLDREM",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-974-5116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.