Plymouth Smiles Dentistry, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PLYMOUTH SMILES DENTISTRY, PC

Doing business as

PLYMOUTH SMILES DENTISTRY

Practice address

3405 Vicksburg LN N Ste 120
Plymouth, MN 55447-1370

Phone

(763) 390-2414

Fax

(763) 290-6811

NPI assigned

Nov 7, 2022

Organization subpart

No

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

Authorized official

Name

Parvathi Jithendrana

Title

Owner

Phone

(763) 390-2614

Specialties & licenses 1

Addresses

Other names 1

• PLYMOUTH SMILES DENTISTRY Doing business as

Locations

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

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1508574773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "763-390-2414",
            "fax_number": "763-290-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 VICKSBURG LN N STE 120",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471370",
            "telephone_number": "763-390-2414",
            "fax_number": "763-290-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH SMILES DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-07",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "JITHENDRANA",
        "authorized_official_first_name": "PARVATHI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-390-2614"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLYMOUTH SMILES DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sara Poff
• Leila Ann Pollock, NP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; 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.