NPIMap

Organization Active NPI

Gerald D. Cavanaugh & William F. Liljemark

Doing business as Edina Orthodontic Associates

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Edina, MN
National Provider Identifier
1447506571
Registry record updated Jul 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D11240,9023,10908AND Issued in MN
Legal business name
GERALD D. CAVANAUGH & WILLIAM F. LILJEMARK
Doing business as
Edina Orthodontic Associates
Practice address
3939 W. 50TH St
Suite #207
Edina, MN 55424-1258
Phone
(952) 926-2335
Fax
(952) 925-0467
NPI assigned
Jul 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2012

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

Authorized official

Name
Scott Robert Bowlby, D.D.S.NPI 1477658359
Title
Managing Partner/Orthodontist
Phone
(952) 926-2335

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
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X D11240,9023,10908AND MN Primary

Addresses

Primary practice location

3939 W. 50TH St
Suite #207
Edina, MN 55424-1258

Mailing address

3939 W. 50TH St
Suite #207
Edina, MN 55424-1258
Phone (952) 926-2335

Other names 1

  • Edina Orthodontic Associates Doing business as

National Provider Directory

National Provider Directory

Locations

3939 W 50th St
Ste 207
Edina, MN 55424
Phone (952) 926-2335

Practitioners & affiliated clinicians

Practitioners 2

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": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343260800000",
    "number": "1447506571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 W. 50TH ST",
            "address_2": "SUITE #207",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241258",
            "telephone_number": "952-926-2335",
            "fax_number": "952-925-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 W. 50TH ST",
            "address_2": "SUITE #207",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241258",
            "telephone_number": "952-926-2335",
            "fax_number": "952-925-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD D. CAVANAUGH & WILLIAM F. LILJEMARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2012-07-26",
        "status": "A",
        "authorized_official_last_name": "BOWLBY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGING PARTNER/ORTHODONTIST",
        "authorized_official_telephone_number": "952-926-2335",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "D11240,9023,10908AND",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edina Orthodontic Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; 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.