NPIMap

Organization Active NPI

Scott D Carlson

  • Dental Clinic/Center
  • Prior Lake, MN
National Provider Identifier
1700495140
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SCOTT D CARLSON
Practice address
4667 Dakota St SE
Prior Lake, MN 55372-1714
Phone
(952) 447-6054
Fax
(952) 447-6139
NPI assigned
Jul 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

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

Authorized official

Name
Geralyn Mary Berens
Title
Office Manager
Phone
(952) 447-6054

Specialties & licenses 1

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

Addresses

Primary practice location

4667 Dakota St SE
Prior Lake, MN 55372-1714

Mailing address

4667 Dakota St SE
Prior Lake, MN 55372-1714
Phone (952) 447-6054

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1700495140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4667 DAKOTA ST SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721714",
            "telephone_number": "952-447-6054",
            "fax_number": "952-447-6139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4667 DAKOTA ST SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721714",
            "telephone_number": "952-447-6054",
            "fax_number": "952-447-6139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT D CARLSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "BERENS",
        "authorized_official_first_name": "GERALYN",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "952-447-6054"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prior Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.