Southridge Dental, PA

Primary specialty

DentistTaxonomy code 122300000X

License

D12847 Issued in MN

Legal business name

SOUTHRIDGE DENTAL, PA

Practice address

1320 Mendota Rd
Inver Grove Heights, MN 55077-1255

Phone

(651) 451-1884

Fax

(651) 306-9709

NPI assigned

Jul 7, 2017

Organization subpart

No

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

Authorized official

Name

Sheryl Bottjen Tandon, DDSNPI 1043522881

Title

Dentist

Phone

(651) 451-1884

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sheryl Bottjen Tandon, DDS

  • Dentist
  • Inver Grove Heights, MN
  • NPI 1043522881
  Medicare reassignment NPD Authorized official
• Michael J Dillon, DDS

  • General Practice Dentistry
  • Inver Grove Heights, MN
  • NPI 1609865286
  NPD (past)

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

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386166734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 MENDOTA RD",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550771255",
            "telephone_number": "651-451-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MENDOTA RD",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550771255",
            "telephone_number": "651-451-1884",
            "fax_number": "651-306-9709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHRIDGE DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TANDON",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_middle_name": "BOTTJEN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "651-451-1884",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Rae Skokan, MACCCSLP
• Beth Carolyn Smith
• Snyders Drug (Snyder Drug Emporium)
• Sol Health LLC
• Samantha Joy Sonstegard, PT, DPT
• Southridge Family Dental
• Spirit in Bloom, LLC
• Daniel R. Stahl, M.D.
• Star Dental
• Grant Stark

• Dentist in Inver Grove Heights, MN
• Providers in Inver Grove Heights, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.