Charles Laurence Shimota, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14898 Issued in MN

Practice address

215 Radio Dr Ste 201
Woodbury, MN 55125-5820

Phone

(651) 739-7910

NPI assigned

Jun 5, 2023

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Woodbury Dental Care

  • Dental Clinic/Center
  • Saint Paul, MN
  • NPI 1790351716
  NPD

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1598459489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 201",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255820",
            "telephone_number": "651-739-7910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 201",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255820",
            "telephone_number": "651-739-7910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIMOTA",
        "first_name": "CHARLES",
        "middle_name": "LAURENCE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shepherd'S Home LLC
• Phillip T. Sheridan, M.D.
• Brian David Sherman, PHYSICIAN ASSISTANT
• Rebecca Martos Sherwood, M.D.
• Greg W Shillings, BS
• Kelly Shin, DDS
• Vanoella Fru Shinwen
• Amy M Shirilla, CRNA
• Annette Louise Shirk, PT
• Erica Shorten

• General Practice Dentistry in Woodbury, MN
• Providers in Woodbury, 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 Jun 5, 2023; 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.