NPIMap

Organization Active NPI

Saint Anthony Village Dentistry

  • Dental Clinic/Center
  • St Anthony, MN
National Provider Identifier
1528535788
Registry record updated Oct 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SAINT ANTHONY VILLAGE DENTISTRY
Practice address
2525 33Rd Ave NE
St Anthony, MN 55418-1539
Phone
(612) 781-9270
Fax
(612) 767-3490
NPI assigned
Oct 25, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2018

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

Authorized official

Name
Dr. Cory John Larson, DDSNPI 1487762548
Title
Dentist
Phone
(612) 789-2853

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2525 33Rd Ave NE
St Anthony, MN 55418-1539

Mailing address

1632 Washington St NE
Minneapolis, MN 55413-1336
Phone (612) 789-2853

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1540425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540425600000",
    "number": "1528535788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1632 WASHINGTON ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131336",
            "telephone_number": "612-789-2853",
            "fax_number": "612-767-9430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 33RD AVE NE",
            "city": "ST ANTHONY",
            "state": "MN",
            "postal_code": "554181539",
            "telephone_number": "612-781-9270",
            "fax_number": "612-767-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT ANTHONY VILLAGE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-25",
        "last_updated": "2018-10-25",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "612-789-2853",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Anthony, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2018; 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.