NPIMap

Organization Active NPI

Immanuel Dental

  • Dentist
  • Farmington, MN
National Provider Identifier
1417070509
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D10129 Issued in MN
Legal business name
IMMANUEL DENTAL
Practice address
321 Third Street
Farmington, MN 55024
Phone
(651) 463-2880
Fax
(651) 463-2840
NPI assigned
Apr 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Authorized official

Name
Dr. Linden K. Dungy, DDSNPI 1548226327
Title
C.E.O.
Phone
(651) 463-2880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D10129 MN Primary

Addresses

Primary practice location

321 Third Street
Farmington, MN 55024

Mailing address

321 Third Street
Farmington, MN 55024
Phone (651) 463-2880

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1417070509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 THIRD STREET",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "55024",
            "telephone_number": "651-463-2880",
            "fax_number": "651-463-2840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 THIRD STREET",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "55024",
            "telephone_number": "651-463-2880",
            "fax_number": "651-463-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMANUEL DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "DUNGY",
        "authorized_official_first_name": "LINDEN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "651-463-2880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.