NPIMap

Organization Active NPI

Periodontal Center

  • Periodontics
  • Hudson, WI
National Provider Identifier
1497348239
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
PERIODONTAL CENTER
Practice address
1610 Maxwell Dr
Hudson, WI 54016-8709
Phone
(715) 690-3050
NPI assigned
Feb 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Authorized official

Name
Patty Barnard
Title
Business Manager
Phone
(651) 233-2140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

1610 Maxwell Dr
Hudson, WI 54016-8709

Mailing address

8401 Seasons Pkwy
Woodbury, MN 55125-3414

Other practice location 1

7791 79th St S
Cottage Grove, MN 55016-1832
Phone (715) 690-3050

Other names 1

  • The Periodontal Center Doing business as

National Provider Directory

National Provider Directory

Locations

7791 79th St S
Cottage Grove, MN 55016
Phone (715) 690-3050

1610 Maxwell Dr
Hudson, WI 54016
Phone (715) 381-9620

Practitioners & affiliated clinicians

Practitioners 5

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": "1613088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613088000000",
    "number": "1497348239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 SEASONS PKWY",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 MAXWELL DR",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168709",
            "telephone_number": "715-690-3050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7791 79th St S",
            "address_purpose": "LOCATION",
            "city": "Cottage Grove",
            "state": "MN",
            "postal_code": "550161832",
            "country_code": "US",
            "telephone_number": "715-690-3050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PERIODONTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "BARNARD",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "651-233-2140"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Periodontal Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hudson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; 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.