Willow Grove Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WILLOW GROVE FAMILY DENTAL

Practice address

28 Nathan LN N
Plymouth, MN 55441-6306

Phone

(763) 544-5555

Fax

(763) 544-0305

NPI assigned

Jul 25, 2013

Organization subpart

Yes

Parent organization

GR SERVICESAs reported in NPPES

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

Authorized official

Name

Mr. Alex Grudsky

Title

Owner - President

Phone

(763) 694-0222

Specialties & licenses 1

Addresses

Part of

Willow Grove Family Dental

Locations

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

{
    "created_epoch": "1374710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1417399965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 NATHAN LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416306",
            "telephone_number": "763-544-5555",
            "fax_number": "763-544-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 NATHAN LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416306",
            "telephone_number": "763-544-5555",
            "fax_number": "763-544-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW GROVE FAMILY DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GR SERVICES",
        "enumeration_date": "2013-07-25",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "GRUDSKY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "OWNER - PRESIDENT",
        "authorized_official_telephone_number": "763-694-0222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roshaunta Jacquese Evora Williams, BA AFRICAN AMERICAN
• Susan Ora Williams, MSW, LICSW
• Lindsay Grace Williamson, OTR/L
• Willow Bay Therapy, LLC
• Willow Creek Family Dental
• Sandra Ann Willson, PT
• Alexander Wilson, PA STUDENT
• Anthony John Wilson
• Nalissa Wilson
• Gerald A Wimmer, D.D.S.

• General Practice Dentistry in Plymouth, MN
• Providers in Plymouth, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.