NPIMap

Organization Active NPI

Wayzata Endodontics PA

  • Endodontics
  • Wayzata, MN
National Provider Identifier
1508926841
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
9011 Issued in MN
Legal business name
WAYZATA ENDODONTICS PA
Practice address
250 N Central Ave
Suite 303
Wayzata, MN 55391
Phone
(952) 476-0070
NPI assigned
Dec 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Dr. Gregory Vincent Otoole, DDS MSNPI 1639121494
Title
President
Phone
(952) 476-0070

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 9011 MN Primary
Endodontics 1223E0200X 11543 MN

Addresses

Primary practice location

250 N Central Ave
Suite 303
Wayzata, MN 55391

Mailing address

250 N Central Ave
Suite 303
Wayzata, MN 55391
Phone (952) 476-0070

National Provider Directory

National Provider Directory
Tax ID family
Wayzata Endodontics PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

250 Central Ave N
Ste 303
Wayzata, MN 55391
Phone (952) 476-0070

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508926841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N CENTRAL AVE",
            "address_2": "SUITE 303",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "55391",
            "telephone_number": "952-476-0070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N CENTRAL AVE",
            "address_2": "SUITE 303",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "55391",
            "telephone_number": "952-476-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYZATA ENDODONTICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OTOOLE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-476-0070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "9011",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "11543",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayzata, 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.