NPIMap

Organization Active NPI

K.O.a.L.a. Dental Care, LLC

  • Pediatric Dentistry
  • Saint Cloud, MN
National Provider Identifier
1710317326
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D11694 Issued in MN
Legal business name
K.O.A.L.A. DENTAL CARE, LLC
Practice address
1521 Northway Dr
Suite 108
Saint Cloud, MN 56303-4489
Phone
(320) 253-8380
Fax
(320) 253-8419
NPI assigned
Nov 18, 2013
Last updated
Nov 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

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

Authorized official

Name
Dr. John David Collier, DDSNPI 1558385377
Title
Owner
Phone
(320) 253-8380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X D11694 MN Primary

Addresses

Primary practice location

1521 Northway Dr
Suite 108
Saint Cloud, MN 56303-4489

Mailing address

20 1St Ave S
Buffalo, MN 55313-1409
Phone (320) 253-8380

National Provider Directory

National Provider Directory
Tax ID family
Koala Dental Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1710317326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 1ST AVE S",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131409",
            "telephone_number": "320-253-8380",
            "fax_number": "320-253-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 NORTHWAY DR",
            "address_2": "SUITE 108",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034489",
            "telephone_number": "320-253-8380",
            "fax_number": "320-253-8419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K.O.A.L.A. DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "COLLIER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-253-8380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D11694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.