Amethyst Dental Care LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AMETHYST DENTAL CARE LLC

Practice address

1751 Highway 52 N
Rochester, MN 55901-1692

Phone

(507) 282-9288

Fax

(507) 292-6622

NPI assigned

Jul 28, 2020

Organization subpart

No

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

Authorized official

Name

Dr. John C. Boeker, DDSNPI 1720073554

Title

Managing Partner

Phone

(507) 288-9288

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Amethyst Dental Care Former legal business name

Electronic endpoints 1

Locations

Practitioners 1

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

• John C Boeker, DDS

  • General Practice Dentistry
  • Rochester, MN
  • NPI 1720073554
  NPD Authorized official

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1609485432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 HIGHWAY 52 N",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559011692",
            "telephone_number": "507-282-9288",
            "fax_number": "507-292-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 HIGHWAY 52 N",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559011692",
            "telephone_number": "507-282-9288",
            "fax_number": "507-292-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMETHYST DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "BOEKER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "507-288-9288",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1841286457",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1720073554",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amethystdental@hotmail.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1751 Highway 52 N",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "559011692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Amethyst Dental Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• General Practice Dentistry in Rochester, MN
• Providers in Rochester, 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 Jul 28, 2020; 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.