Correctional Dentistry, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CORRECTIONAL DENTISTRY, LLC

Practice address

3152 County Road 74
Saint Cloud, MN 56301-8904

Phone

(320) 774-3131

Fax

(320) 217-2877

NPI assigned

Aug 24, 2022

Organization subpart

No

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

Authorized official

Name

Julie Ann Benoit

Title

Practice Administrator

Phone

(320) 774-3131

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1326767237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3152 COUNTY ROAD 74",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563018904",
            "telephone_number": "320-774-3131",
            "fax_number": "320-217-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3152 COUNTY ROAD 74",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563018904",
            "telephone_number": "320-774-3131",
            "fax_number": "320-217-2877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORRECTIONAL DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "BENOIT",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "320-774-3131"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "julie@stonegatedentalassociates.com",
            "affiliation": "Y",
            "affiliationName": "Stone Gate Dental Associates Inc.",
            "address_1": "3152 County Road 74",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563018904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dental Clinic/Center in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.