Hanover Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D13236 Issued in MN

Legal business name

HANOVER DENTAL PLLC

Doing business as

Hanover Dental

Practice address

411 Labeaux Ave NE
Hanover, MN 55341

Phone

(763) 400-3005

NPI assigned

Jun 7, 2018

Last updated

Jun 7, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tyler James Koivisto, DDS

Title

Dentist

Phone

(763) 226-7379

Specialties & licenses 1

Addresses

Other names 1

• Hanover Dental Doing business as

Locations

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1487147260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1192 BICE AVE NW",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553134456",
            "telephone_number": "763-226-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 LABEAUX AVE NE",
            "city": "HANOVER",
            "state": "MN",
            "postal_code": "55341",
            "telephone_number": "763-400-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANOVER DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-07",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "KOIVISTO",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "763-226-7379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D13236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hanover Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hanover Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Hanover, MN
• Providers in Hanover, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.