Miracle Mile Dentistry PA

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MIRACLE MILE DENTISTRY PA

Practice address

5806A W 36TH St
St Louis Park, MN 55416-5108

Phone

(952) 929-5292

NPI assigned

Mar 13, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Michael Dunlavey, DDS

Title

President

Phone

(612) 799-7525

Specialties & licenses 1

Addresses

Other names 1

• 36th Street Dental Doing business as

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

{
    "created_epoch": "1426204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426204800000",
    "number": "1417340563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5806A W 36TH ST",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165108",
            "telephone_number": "952-929-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5806A W 36TH ST",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165108",
            "telephone_number": "952-929-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE MILE DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-13",
        "last_updated": "2015-03-13",
        "status": "A",
        "authorized_official_last_name": "DUNLAVEY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-799-7525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "36th Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Megan A. Misgen, CNP
• Shardendu Mishra, MBBS
• Agne Miskinis
• Andrew James Misselt, MD

• Dentist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; 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.