Organization Active NPI

Proactive Healthcare Education Center

  • Public Health Dentistry
  • Minneapolis, MN
National Provider Identifier
1528805553
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
Legal business name
PROACTIVE HEALTHCARE EDUCATION CENTER
Doing business as
Proactive Dental Clinic Corp
Practice address
334 E Lake St Ste 105
Minneapolis, MN 55408-2485
Phone
(310) 883-8932
NPI assigned
Jul 9, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Solaman Shire
Title
Administrator
Phone
(310) 883-8932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X Primary

Addresses

Primary practice location

334 E Lake St Ste 105
Minneapolis, MN 55408-2485

Mailing address

334 E Lake St Ste 105
Minneapolis, MN 55408-2485

Other names 1

  • Proactive Dental Clinic Corp Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Proactive Dental Clinic Corp2 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

334 E Lake St
Ste 105
Minneapolis, MN 55408
Phone (310) 883-8932

Practitioners & affiliated clinicians

Practitioners 1

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": "1720483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1528805553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "334 E LAKE ST STE 105",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 E LAKE ST STE 105",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082485",
            "telephone_number": "310-883-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE HEALTHCARE EDUCATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "SHIRE",
        "authorized_official_first_name": "SOLAMAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "310-883-8932"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive Dental Clinic Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.