Active NPI
Jacqueline Medina, DDS
- General Practice Dentistry
- Minneapolis, MN
National Provider Identifier
1679718514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 37453
- Practice address
- 515 Delaware St SE FL 6
Minneapolis, MN 55455-0357 - Phone
- (612) 625-5945
- NPI assigned
- Dec 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 37453 | CA | Primary |
Addresses
Primary practice location
515 Delaware St SE FL 6
Minneapolis, MN 55455-0357
Mailing address
7-530 Moos Tower
515 Delaware St SE
Minneapolis, MN 55455-0357
Phone (612) 625-5945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37453 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559606400000",
"number": "1679718514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7-530 MOOS TOWER",
"address_2": "515 DELAWARE ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550357",
"telephone_number": "612-625-5945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 DELAWARE ST SE FL 6",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550357",
"telephone_number": "612-625-5945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "JACQUELINE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-05",
"last_updated": "2019-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "37453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.