NPIMap

Organization Active NPI

Minnesota Dental Professionals, P.C.

Doing business as Southwest Dental Care

  • General Practice Dentistry
  • Forest Lake, MN
National Provider Identifier
1619451192
Registry record updated Dec 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MINNESOTA DENTAL PROFESSIONALS, P.C.
Doing business as
Southwest Dental Care
Practice address
107 12TH St SW Ste 2
Forest Lake, MN 55025-1467
Phone
(612) 261-4998
NPI assigned
Sep 20, 2018
Last updated
Dec 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MINNESOTA DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2018

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

Authorized official

Name
Jessica Britt
Title
Credentialing Coordinator
Phone
(217) 540-8426

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

107 12TH St SW Ste 2
Forest Lake, MN 55025-1467

Mailing address

107 12TH St SW Ste 2
Forest Lake, MN 55025-1467
Phone (651) 964-2013

Other names 1

  • Southwest Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Dental Professionals PC23 organizations share this tax ID, including this one
Part of
Minnesota Dental Professionals PC

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

107 12th St SW
#2
Forest Lake, MN 55025
Phone (612) 261-4998

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": "1537401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1619451192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 12TH ST SW STE 2",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550251467",
            "telephone_number": "651-964-2013",
            "fax_number": "651-272-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 12TH ST SW STE 2",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550251467",
            "telephone_number": "612-261-4998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2018-09-20",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8426"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.