Integra Dental PA

Primary specialty

DentistTaxonomy code 122300000X

License

D12655 Issued in MN

Legal business name

INTEGRA DENTAL PA

Practice address

13783 Ibis St NW
Suite 400
Andover, MN 55304-4892

Phone

(612) 384-0527

NPI assigned

Apr 30, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Gina L Andersland, D.D.S.

Title

Owner/Dentist

Phone

(612) 384-0527

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1508201997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13783 IBIS ST NW",
            "address_2": "SUITE 400",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553044892",
            "telephone_number": "612-384-0527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13783 IBIS ST NW",
            "address_2": "SUITE 400",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553044892",
            "telephone_number": "612-384-0527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRA DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-30",
        "last_updated": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "ANDERSLAND",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "612-384-0527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12655",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13123",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Andover, MN
• Providers in Andover, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; 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.