Russell Allen Dylla, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D12016 Issued in MN

Practice address

6545 France Ave S
Suite #190
Edina, MN 55435-2131

Phone

(952) 922-6949

NPI assigned

Jun 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Southdale Periodontics, PLLC

  • Periodontics
  • Edina, MN
  • NPI 1134547730
  NPD (past) Authorized official
• Southdale Periodontics

  • Periodontics
  • Edina, MN
  • NPI 1326044538
  NPD (past)

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1710180294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVE S STE 190",
            "address_2": "SUITE #190",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352184",
            "telephone_number": "952-922-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVE S",
            "address_2": "SUITE #190",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352131",
            "telephone_number": "952-922-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYLLA",
        "first_name": "RUSSELL",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-11",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D12016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul G Dworak, M.D.
• Laura Dwyer, LMFT
• Sean Sullivan Dwyer, PA-C
• Derek S Dyess, M.D.
• Dylla-Jensen Periodontics PLLC
• Arnela Dzihic
• E-Quip Inc
• Mary Eaton, M.D.
• Jody Eberman, RN
• Jean-Marie R Ebrahimi, MD

• Periodontics in Edina, MN
• Providers in Edina, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.