NPIMap

Organization Active NPI

Enterprise Dental, Inc.

  • General Practice Dentistry
  • Mendota Heights, MN
National Provider Identifier
1447422175
Registry record updated Apr 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D10401 Issued in MN
Legal business name
ENTERPRISE DENTAL, INC.
Practice address
2418 Enterprise Dr Unit B
Mendota Heights, MN 55120-1361
Phone
(651) 452-2116
Fax
(651) 452-2695
NPI assigned
Apr 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2008

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

Authorized official

Name
Dr. Wendy Lee Koury, D.D.S.NPI 1578551503
Title
President
Phone
(651) 452-2116

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D10401 MN Primary

Addresses

Primary practice location

2418 Enterprise Dr Unit B
Mendota Heights, MN 55120-1361

Mailing address

2418 Enterprise Dr Unit B
Mendota Heights, MN 55120-1361
Phone (651) 452-2116

National Provider Directory

National Provider Directory

Locations

2418 Enterprise Dr
Unit B
Mendota Heights, MN 55120
Phone (651) 452-2116

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1447422175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2418 ENTERPRISE DR UNIT B",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201361",
            "telephone_number": "651-452-2116",
            "fax_number": "651-452-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 ENTERPRISE DR UNIT B",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201361",
            "telephone_number": "651-452-2116",
            "fax_number": "651-452-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENTERPRISE DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "KOURY",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-452-2116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendota Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; 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.