Anthony A. Indovina Jr., DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D12045 Issued in MN

Practice address

2130 Cliff Rd
Suite 100
Eagan, MN 55122-2485

Phone

(651) 452-6933

Fax

(651) 905-3061

NPI assigned

Dec 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Other, 2000

Medicare assignment

May accept Medicare assignment

Group practices

Dakota Valley Oral and Maxillofacial Surgery PLLCGroup PAC ID 9436127560, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dakota Valley Oral and Maxillofacial Surgery, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Paul, MN
  • NPI 1366568206
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548323033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 CLIFF RD",
            "address_2": "SUITE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222485",
            "telephone_number": "651-452-6933",
            "fax_number": "651-905-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 CLIFF RD",
            "address_2": "SUITE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222485",
            "telephone_number": "651-452-6933",
            "fax_number": "651-905-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INDOVINA",
        "first_name": "ANTHONY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D12045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Imani Services L.L.C.
• Imis MN Inc (Pearle Vision)
• Impact Health Care Inc
• In-Alignment Counseling, LLC
• In-Home Lab Connection Inc.
• Infinite Health Collaborative, PA
• Integrated Motion Pediatric Physical Therapy, Inc.
• Integrity Transportation Service
• Intergalactic Therapy Centre LLC
• Alan Irvin

• Oral and Maxillofacial Surgery (Dentist) in Eagan, MN
• Providers in Eagan, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.