Tracy M. St. Dennis, D.D.S., PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

TRACY M. ST. DENNIS, D.D.S., PLLC

Practice address

3475 Willow Lake Blvd
Suite 100
Vadnais Heights, MN 55110-5156

Phone

(651) 341-2106

NPI assigned

Oct 28, 2016

Organization subpart

No

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

Authorized official

Name

Mark St Dennis

Title

General Manager

Phone

(651) 341-2106

Specialties & licenses 1

Addresses

Other names 1

• Willow Lake Dental Doing business as

Locations

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

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477612800000",
    "number": "1508318247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 WILLOW LAKE BLVD",
            "address_2": "SUITE 100",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105156",
            "telephone_number": "651-341-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 WILLOW LAKE BLVD",
            "address_2": "SUITE 100",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105156",
            "telephone_number": "651-341-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY M. ST. DENNIS, D.D.S., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-28",
        "last_updated": "2016-10-28",
        "status": "A",
        "authorized_official_last_name": "ST DENNIS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "651-341-2106"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Lake Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Thoma, CCC-SLP
• Richard James Thomas
• Elizabeth Jean Thompson, RD
• Allyne Topaz, M.D.
• Nelsie Toussaint
• William R Turnquist, SA-C
• Twin Brothers Health Care LLC
• Ultimate Healthcare Services LLC
• Anwar Muhammad Umar
• Urwc, PA

• Dental Clinic/Center in Vadnais Heights, MN
• Providers in Vadnais Heights, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2016; 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.