Grove Dentist PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11844 Issued in MN

Legal business name

GROVE DENTIST PA

Practice address

13649 Grove Dr
Maple Grove, MN 55311-4405

Phone

(763) 420-8038

Fax

(763) 494-4222

NPI assigned

Apr 10, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Reny Chacko

Title

Dentist

Phone

(651) 308-2804

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1326481284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13649 GROVE DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114405",
            "telephone_number": "763-420-8038",
            "fax_number": "763-494-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13649 GROVE DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114405",
            "telephone_number": "763-420-8038",
            "fax_number": "763-494-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROVE DENTIST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-10",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "CHACKO",
        "authorized_official_first_name": "RENY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "651-308-2804",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Groebel, OTR/L
• Jody Groebner, PTA
• Viola Luna Grommes
• Jayme Gronneberg, PHARMD
• Ellen Gross, OTD, OTR/L
• Grove Health Dental PLLC
• Emily Claire Grund, MS
• Riley Grussing
• Tanveer Gulzar
• Guse Chiropractic, P.a.

• General Practice Dentistry in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; 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.