Mahtomedi Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7721 Issued in MN

Legal business name

MAHTOMEDI FAMILY DENTAL

Practice address

814 Mahtomedi Ave
Mahtomedi, MN 55115-1730

Phone

(651) 426-0011

NPI assigned

Oct 3, 2013

Last updated

Oct 3, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian Welle

Title

Doctor

Phone

(651) 426-0011

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1720415896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 MAHTOMEDI AVE",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 MAHTOMEDI AVE",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151730",
            "telephone_number": "651-426-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHTOMEDI FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "WELLE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "651-426-0011",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D7721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811212624",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Livant
• Lumn Therapy, LLC
• Avery Grace Macintosh
• Mahtomedi Dental Clinic
• Mahtomedi Dental Clinic
• Mahtomedi Natural Care Center
• Shannon Maixner, PT
• Kaitlyn Matteson, MA, LADC
• Sara Elaine McGrath, MS-CCC, SLP
• Aria Elizabeth Mullin, LMFT

• General Practice Dentistry in Mahtomedi, MN
• Providers in Mahtomedi, MN by specialty
• General Practice Dentistry in Minnesota

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