Abhina Gautam, MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

S215 Issued in MN

Practice address

2680 E Snelling Ser Dr
100
Roseville, MN 55113

Phone

(612) 662-0121

NPI assigned

Feb 12, 2020

Last updated

Aug 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1588296024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E GRANT ST APT 1706",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041476",
            "telephone_number": "352-214-4330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 E SNELLING SER DR",
            "address_2": "100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "612-662-0121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1395 Center Dr",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326103006",
            "country_code": "US",
            "telephone_number": "352-273-6910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAUTAM",
        "first_name": "ABHINA",
        "name_prefix": "Dr.",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-12",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "FL",
            "license": "DPRM2096",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MN",
            "license": "S215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Eloy Garcia, LICSW
• Heather Garibaldi-Davis
• Luis Garibay, MSW, LGSW
• Lisa Garrity, OT
• Jolie Garvin, LAT
• James Michael Gee, M.D., PH.D.
• Alyssa Geiken
• Michael Warren Geiser, DDS
• Mehmet Gencturk, M.D
• Genoa Healthcare Clinical Laboratory LLC (Genoa Healthcare)

• Prosthodontics in Roseville, MN
• Providers in Roseville, MN by specialty
• Prosthodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.