Active NPI
Todd Alan Porter, DDS
- Dentist
- Burnsville, MN
National Provider Identifier
1720308794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D11535
- Practice address
- 50 McAndrews Rd E
Burnsville, MN 55337-5718 - Phone
- (952) 892-5050
- NPI assigned
- Jun 1, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D11535 | MN | Primary |
| Dentist | 122300000X | WI5940 | WI |
Addresses
Primary practice location
50 McAndrews Rd E
Burnsville, MN 55337-5718
Mailing address
50 McAndrews Rd E
Burnsville, MN 55337-5718
Phone (952) 892-5050
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160428001386 | MN | Order and Referring Only - Oral Surgery | 0648579409 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11535 | MN | MD | Dentist |
| WI5940 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469404800000",
"number": "1720308794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 MCANDREWS RD E",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553375718",
"telephone_number": "952-892-5050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 MCANDREWS RD E",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553375718",
"telephone_number": "952-892-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "TODD",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-01",
"last_updated": "2016-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D11535",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "WI5940",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.