Individual provider Active NPI

Amruta N Naik

  • Dentist
  • Maple Grove, MN
National Provider Identifier
1639669203
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D13991 Issued in MN
Practice address
9630 Grove Cir N
Maple Grove, MN 55369-3464
Phone
(763) 420-5464
NPI assigned
May 18, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D13991 MN Primary

Addresses

Primary practice location

9630 Grove Cir N
Maple Grove, MN 55369-3464

Mailing address

11550 Arbor Lakes Parkway
Apt 1206
Maple Grove, MN 55369
Phone (716) 866-9969

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190521000721 MN Order and Referring Only - DentistPractitioner - Dentist 4789927450

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526601600000",
    "number": "1639669203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11550 ARBOR LAKES PARKWAY",
            "address_2": "APT 1206",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "716-866-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9630 GROVE CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553693464",
            "telephone_number": "763-420-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAIK",
        "first_name": "AMRUTA",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-18",
        "last_updated": "2018-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.