NPIMap

Organization Active NPI

Straight Smiles, PLLC

  • Dental Clinic/Center
  • Fridley, MN
National Provider Identifier
1679904189
Registry record updated Dec 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
STRAIGHT SMILES, PLLC
Practice address
1109 Moore Lake Dr E
Fridley, MN 55432-5171
Phone
(763) 572-2224
Fax
(763) 572-2226
NPI assigned
Dec 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2013

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

Authorized official

Name
Dr. John Gulon
Title
President
Phone
(651) 633-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1109 Moore Lake Dr E
Fridley, MN 55432-5171

Mailing address

2200 County Road C W
Suite 2210
Roseville, MN 55113-2550
Phone (651) 633-0500

Other names 1

  • Northern Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northern Orthodontics4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1109 Moore Lake Dr E
Fridley, MN 55432
Phone (651) 439-2600

NPI Registry JSON

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386547200000",
    "number": "1679904189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W",
            "address_2": "SUITE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132550",
            "telephone_number": "651-633-0500",
            "fax_number": "651-636-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 MOORE LAKE DR E",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325171",
            "telephone_number": "763-572-2224",
            "fax_number": "763-572-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRAIGHT SMILES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2013-12-09",
        "status": "A",
        "authorized_official_last_name": "GULON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-633-0500",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; 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.