Mnpl02 PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MNPL02 PLLC

Practice address

1099 Helmo Ave N Ste 110
Oakdale, MN 55128-6034

Phone

(651) 372-3300

Fax

(651) 337-8305

NPI assigned

Jul 19, 2023

Organization subpart

No

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

Authorized official

Name

Nicholas Bussa, DDS

Title

Member

Phone

(218) 349-8564

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1407536196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14300 CLAY TERRACE BLVD STE 249",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323636",
            "telephone_number": "317-502-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 HELMO AVE N STE 110",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551286034",
            "telephone_number": "651-372-3300",
            "fax_number": "651-337-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MNPL02 PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A",
        "authorized_official_last_name": "BUSSA",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "218-349-8564",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.