Advanced Family Dental PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12409 Issued in MN

Legal business name

ADVANCED FAMILY DENTAL PA

Practice address

2717 Ekko Ave
Albert Lea, MN 56007-2070

Phone

(507) 373-5968

Fax

(507) 540-1395

NPI assigned

Aug 24, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Rachel Anne PoppelNPI 1467651497

Title

Owner

Phone

(507) 373-5968

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rachel Anne Poppel, DDS

  • Dentist
  • Albert Lea, MN
  • NPI 1467651497
  NPD Authorized official
• Tricia Rose Nelson, D.D.S.

  • General Practice Dentistry
  • Albert Lea, MN
  • NPI 1922411438
  NPD (past)

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1548540321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 EKKO AVE",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072070",
            "telephone_number": "507-373-5968",
            "fax_number": "507-540-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2717 EKKO AVE",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072070",
            "telephone_number": "507-373-5968",
            "fax_number": "507-540-1395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FAMILY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "POPPEL",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-373-5968",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12409",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A David Flor DDS LTD
• Lise Holm Aasheim, M.D.
• Accumed Healthcare LLC
• Ahadi Inc
• Ammar Alam
• Albert Lea Chiropractic and Massage, PLLC
• Albert Lea Chiropractic, PLC
• Albert Lea Dental Clinic PA

• General Practice Dentistry in Albert Lea, MN
• Providers in Albert Lea, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.