NPIMap

Organization Active NPI

MSP Dentistry, Inc.

  • Preferred Provider Organization
  • Champlin, MN
National Provider Identifier
1558719922
Registry record updated May 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
D12034 Issued in MN
Legal business name
MSP DENTISTRY, INC.
Practice address
12027 Business Park Blvd N
Champlin, MN 55316-4526
Phone
(763) 421-7900
Fax
(763) 421-7916
NPI assigned
May 26, 2016
Last updated
May 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2016

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

Authorized official

Name
Dr. Majid Fehresti, D.D.S.
Title
Owner/Dentist
Phone
(763) 421-7900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X D12034 MN Primary

Addresses

Primary practice location

12027 Business Park Blvd N
Champlin, MN 55316-4526

Mailing address

12027 Business Park Blvd N
Champlin, MN 55316-4526
Phone (763) 421-7900

Other names 1

  • Twin Cities Dental Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
MSP Dentistry Inc2 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.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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": "1464220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1558719922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12027 BUSINESS PARK BLVD N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553164526",
            "telephone_number": "763-421-7900",
            "fax_number": "763-421-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12027 BUSINESS PARK BLVD N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553164526",
            "telephone_number": "763-421-7900",
            "fax_number": "763-421-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSP DENTISTRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-26",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "FEHRESTI",
        "authorized_official_first_name": "MAJID",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "763-421-7900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MN",
            "license": "D12034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twin Cities Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Champlin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; 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.