CLD - Coon Rapids MN, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CLD - COON RAPIDS MN, LLC

Practice address

3790 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2629

Phone

(763) 200-5280

NPI assigned

Jun 5, 2023

Organization subpart

No

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

Authorized official

Name

Dr. David Park, DMD

Title

Ceo/Owner

Phone

(651) 444-9644

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1366136269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3790 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3790 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332629",
            "telephone_number": "763-200-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLD - COON RAPIDS MN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "651-444-9644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Chun, MD
• Grace Anne Cimino, M.S.
• Gregory Alexander Clark, O.D.
• Misty Lee Clark
• Rachel Clark, PTA
• Jay Robert Clemens, LADC
• Jenna Michele Clements, PA
• Dean J Cochrane, CRNA
• Lisa Y Cole, CRNA
• Sheila M Cole, PT

• Dental Clinic/Center in Coon Rapids, MN
• Providers in Coon Rapids, 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 Jun 5, 2023; 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.