Brian Patrick Mondale, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11465 Issued in MN

Practice address

10590 Wayzata Blvd
#270
Minnetonka, MN 55305-5512

Phone

(952) 512-8500

Fax

(952) 512-8592

NPI assigned

Dec 13, 2006

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mondale Dental LLC

  • General Practice Dentistry
  • Plymouth, MN
  • NPI 1053834481
  NPD (past) Authorized official

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1598826182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 OLD COUNTY RD 15",
            "address_2": "SUITE 120",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55441",
            "telephone_number": "763-512-8500",
            "fax_number": "763-512-8592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10590 WAYZATA BLVD",
            "address_2": "#270",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055512",
            "telephone_number": "952-512-8500",
            "fax_number": "952-512-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONDALE",
        "first_name": "BRIAN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory John Mohrenweiser, CRNA
• Brett Moldenhauer
• Marsha Kay Molinari, L.I.C.S.W.
• Karen L Mollner, PA
• Sarah Monahan, CCC-SLP
• Charles Mongare
• Cassandra Mongold
• Moniza Psychological Services
• Susanna Monroe, ARNP
• Patricia C Montgomery, PT,PHD

• General Practice Dentistry in Minnetonka, MN
• Providers in Minnetonka, 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 Dec 16, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.