Russomanno Keane DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

RUSSOMANNO KEANE DDS PA

Practice address

1975 11TH Ave E
Maplewood, MN 55109-5148

Phone

(651) 770-2900

NPI assigned

Jul 24, 2020

Organization subpart

No

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

Authorized official

Name

Sam Jacobson

Title

Business Manager

Phone

(651) 307-4966

Specialties & licenses 1

Addresses

Other names 1

• Bluejay Family Dentistry Doing business as

Locations

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1720697808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8910 PENN AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554312025",
            "telephone_number": "952-881-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 11TH AVE E",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095148",
            "telephone_number": "651-770-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSOMANNO KEANE DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "651-307-4966"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluejay Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rowh Chiropractic Enterprises P.a.
• Ryan Rowlson
• Sharon P Roznick, NNP
• David Glenn Runion, L.M.F.T.
• Erin Russell
• Kimberly O Ryan, MA LP
• Ali Sajjad, MD
• Samir N. Salama, MD
• Salams Care Residential, LLC
• Deko Salim

• General Practice Dentistry in Maplewood, MN
• Providers in Maplewood, 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 Jul 24, 2020; 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.