NPIMap

Organization Active NPI

Smisek Family Dentistry P.a.

  • General Practice Dentistry
  • Shoreview, MN
National Provider Identifier
1457570194
Registry record updated Jul 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9783 Issued in MN
Legal business name
SMISEK FAMILY DENTISTRY P.A.
Practice address
501 Tanglewood Dr
Shoreview, MN 55126-2016
Phone
(651) 483-6747
Fax
(651) 483-1863
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2008

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

Authorized official

Name
Gary Ralph Smisek, DDSNPI 1457322489
Title
President Smisek Family Dentistry
Phone
(651) 483-6747

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 7909 MN
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 9783 MN Primary

Addresses

Primary practice location

501 Tanglewood Dr
Shoreview, MN 55126-2016

Mailing address

501 Tanglewood Dr
Shoreview, MN 55126-2016
Phone (651) 483-6747

Other identifiers 2

IdentifierTypeStateIssuer
41-124-3604OtherFEDERAL ID. NUMBER
66340-47OtherMNSTATE MN ID NUMBER

National Provider Directory

National Provider Directory

Locations

501 Tanglewood Dr
Shoreview, MN 55126
Phone (651) 483-6747

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": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1457570194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 TANGLEWOOD DR",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262016",
            "telephone_number": "651-483-6747",
            "fax_number": "651-483-1863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 TANGLEWOOD DR",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262016",
            "telephone_number": "651-483-6747",
            "fax_number": "651-483-1863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMISEK FAMILY DENTISTRY P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "SMISEK",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "RALPH",
        "authorized_official_title_or_position": "PRESIDENT SMISEK FAMILY DENTISTRY",
        "authorized_official_telephone_number": "651-483-6747",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "7909",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL ID. NUMBER",
            "identifier": "41-124-3604",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MN ID NUMBER",
            "identifier": "66340-47",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.