NPIMap

Organization Active NPI

Excel Dentistry PLLC

  • Dentist
  • Wayzata, MN
National Provider Identifier
1720413263
Registry record updated Sep 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D12180 Issued in MN
Legal business name
EXCEL DENTISTRY PLLC
Practice address
1421 Wayzata Blvd
Suite 320
Wayzata, MN 55391-1939
Phone
(952) 475-2907
Fax
(952) 475-2343
NPI assigned
Sep 3, 2013
Last updated
Sep 3, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2013

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

Authorized official

Name
Aleksandr Shibko, DDS
Title
Partner
Phone
(952) 746-3233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D12180 MN Primary

Addresses

Primary practice location

1421 Wayzata Blvd
Suite 320
Wayzata, MN 55391-1939

Mailing address

1421 Wayzata Blvd
Suite 320
Wayzata, MN 55391-1939
Phone (952) 475-2907

National Provider Directory

National Provider Directory
Tax ID family
Excel Dentistry4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1421 Wayzata Blvd
Ste 320
Wayzata, MN 55391
Phone (952) 473-2674

NPI Registry JSON

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378166400000",
    "number": "1720413263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 WAYZATA BLVD",
            "address_2": "SUITE 320",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911939",
            "telephone_number": "952-475-2907",
            "fax_number": "952-475-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 WAYZATA BLVD",
            "address_2": "SUITE 320",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911939",
            "telephone_number": "952-475-2907",
            "fax_number": "952-475-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "SHIBKO",
        "authorized_official_first_name": "ALEKSANDR",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "952-746-3233",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayzata, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.