NPIMap

Organization Active NPI

Jordan Dental Care, P.a.

  • General Practice Dentistry
  • Jordan, MN
National Provider Identifier
1508086455
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D11804 Issued in MN
Legal business name
JORDAN DENTAL CARE, P.A.
Practice address
224 Broadway St S
Jordan, MN 55352-1557
Phone
(952) 492-2021
Fax
(952) 492-6505
NPI assigned
Apr 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Elizabeth M Thelemann-ZunigaNPI 1518944859
Title
Owner-President
Phone
(952) 492-2021

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D11804 MN Primary

Addresses

Primary practice location

224 Broadway St S
Jordan, MN 55352-1557

Mailing address

224 Broadway St S
Jordan, MN 55352-1557
Phone (952) 492-2021

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508086455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 BROADWAY ST S",
            "city": "JORDAN",
            "state": "MN",
            "postal_code": "553521557",
            "telephone_number": "952-492-2021",
            "fax_number": "952-492-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 BROADWAY ST S",
            "city": "JORDAN",
            "state": "MN",
            "postal_code": "553521557",
            "telephone_number": "952-492-2021",
            "fax_number": "952-492-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN DENTAL CARE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THELEMANN-ZUNIGA",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER-PRESIDENT",
        "authorized_official_telephone_number": "952-492-2021"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jordan, MN

Sources for this page

  • 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.