Active NPI
Mohammad Ayyub
- Dentist
- Brooklyn Center, MN
National Provider Identifier
1396436747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14892
- Practice address
- 1090 Shingle Creek Xing
Brooklyn Center, MN 55430-2684 - Phone
- (651) 583-7256
- NPI assigned
- May 17, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D14892 | MN | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1090 Shingle Creek Xing
Brooklyn Center, MN 55430-2684
Mailing address
1601 6TH Ave N
Sartell, MN 56377-1471
Phone (320) 267-0147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14892 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Consultants LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Brooklyn Center, MN
- NPI 1689038473
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685923200000",
"number": "1396436747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 6TH AVE N",
"city": "SARTELL",
"state": "MN",
"postal_code": "563771471",
"telephone_number": "320-267-0147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1090 SHINGLE CREEK XING",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302684",
"telephone_number": "651-583-7256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AYYUB",
"first_name": "MOHAMMAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-17",
"last_updated": "2023-06-05",
"certification_date": "2023-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14892",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Center, MN
Sources for this page
- 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.