Michael K Sutley DDS PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D9086 Issued in MN

Legal business name

MICHAEL K SUTLEY DDS PA

Doing business as

minneapolis oral & maxillofacial surgery

Practice address

825 Nicollet Mall
Suite 707 Medical Arts Building
Minneapolis, MN 55402-2606

Phone

(612) 333-3381

Fax

(612) 334-3318

NPI assigned

Feb 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael K Sutley, DDSNPI 1316000755

Title

President

Phone

(612) 333-3381

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• minneapolis oral & maxillofacial surgery Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael K Sutley, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Minneapolis, MN
  • NPI 1316000755
  NPD (past) Authorized official

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497890594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL",
            "address_2": "SUITE 707 MEDICAL ARTS BUILDING",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022606",
            "telephone_number": "612-333-3381",
            "fax_number": "612-334-3318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL",
            "address_2": "SUITE 707 MEDICAL ARTS BUILDING",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022606",
            "telephone_number": "612-333-3381",
            "fax_number": "612-334-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL K SUTLEY DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SUTLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-333-3381",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D9086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "41426OR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA MEDICAL",
            "identifier": "8080107",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "01007972",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA DENTAL",
            "identifier": "8622286",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "minneapolis oral & maxillofacial surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hassan Shahid Mian, MD
• Iqra Shahid Mian, M.D.
• Micah House
• Frances Lee Mican, LMFT
• Michael J King DDS PA
• Michael P. Browne, PH.D., P.a.
• Michael Rosentreter LLC (Lyn Lake Massage)
• Michael T Brooks LLC
• Justine Michael-Gilbert, MS, LPCC
• Amit Michael, MD

• Oral and Maxillofacial Surgery (Dentist) in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.