Imagine Orthodontics

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

11778 Issued in MN

Legal business name

IMAGINE ORTHODONTICS

Practice address

14020 Northdale Blvd
Rogers, MN 55374-9612

Phone

(763) 428-1912

NPI assigned

Sep 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Sarah Marie Soltys Larson, DDS

Title

President

Phone

(612) 802-4673

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1417142175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14096 STARLITE DR",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553745812",
            "telephone_number": "763-428-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14020 NORTHDALE BLVD",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749612",
            "telephone_number": "763-428-1912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "SOLTYS LARSON",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-802-4673",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "11778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Rogers, MN
• Providers in Rogers, MN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.