Active NPI
Jonathan C Moren, D.D.S.
- General Practice Dentistry
- Minneapolis, MN
National Provider Identifier
1710074638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- MN9493
- Practice address
- 410 Church St SE
Minneapolis, MN 55455 - Phone
- (612) 625-5430
- Fax
- (612) 625-0539
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 | MN9493 | MN | Primary |
Addresses
Primary practice location
410 Church St SE
Minneapolis, MN 55455
Mailing address
4940 Viking Dr Ste 127
Edina, MN 55435-5306
Phone (952) 835-3383
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MN9493 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pentagon Dental Group, LTD | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Edina, MN
- NPI 1629166566
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526947200000",
"number": "1710074638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4940 VIKING DR STE 127",
"city": "EDINA",
"state": "MN",
"postal_code": "554355306",
"telephone_number": "952-835-3383",
"fax_number": "952-835-2818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 CHURCH ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-625-5430",
"fax_number": "612-625-0539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOREN",
"first_name": "JONATHAN",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2018-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "MN9493",
"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 May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.