Active NPI
Shannon Marie Doerge Nascene, DDS
- General Practice Dentistry
- Edina, MN
National Provider Identifier
1497814388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D11560
- Practice address
- 6545 France Ave S
#390
Edina, MN 55435-2131 - Phone
- (952) 926-3534
- Fax
- (952) 926-7085
- NPI assigned
- Dec 6, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D11560 | MN | Primary |
Addresses
Primary practice location
6545 France Ave S
#390
Edina, MN 55435-2131
Mailing address
4345 Portland Ave
Minneapolis, MN 55407-3138
Phone (612) 822-1656
Other names 1
- Dr. Shannon Marie Doerge
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11560 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PDG,P.a. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497814388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4345 PORTLAND AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073138",
"telephone_number": "612-822-1656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6545 FRANCE AVE S",
"address_2": "#390",
"city": "EDINA",
"state": "MN",
"postal_code": "554352131",
"telephone_number": "952-926-3534",
"fax_number": "952-926-7085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOERGE NASCENE",
"first_name": "SHANNON",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D11560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "DOERGE",
"middle_name": "MARIE",
"prefix": "DR.",
"credential": "DDS",
"code": "2",
"type": "Professional Name"
}
]
}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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.