Serenity Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SERENITY DENTAL CORPORATION

Practice address

563 Beielberg Drive
210
Woodbury, MN 55125

Phone

(651) 414-0208

Fax

(651) 414-0390

NPI assigned

Nov 20, 2020

Organization subpart

No

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

Authorized official

Name

Cyrus Mahmoodi

Title

Owner

Phone

(651) 414-0208

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1659974665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "563 BEIELBERG DRIVE",
            "address_2": "210",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "55125",
            "telephone_number": "651-414-0208",
            "fax_number": "651-414-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "563 BEIELBERG DRIVE",
            "address_2": "210",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "55125",
            "telephone_number": "651-414-0208",
            "fax_number": "651-414-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "MAHMOODI",
        "authorized_official_first_name": "CYRUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-414-0208"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Nov 20, 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.