NPIMap

Organization Active NPI

Metropolitan Pediatric Dental Associates, LTD

  • Pediatric Dentistry
  • Fridley, MN
National Provider Identifier
1730238767
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD
Practice address
500 Osborne Rd NE
Suite 345
Fridley, MN 55432-2765
Phone
(763) 786-4260
Fax
(651) 224-4969
NPI assigned
Jan 9, 2007
Organization subpart
Yes
Parent organization
METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
James D Nickmna, DDS
Title
President
Phone
(651) 224-4969

Specialties & licenses 1

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

Addresses

Primary practice location

500 Osborne Rd NE
Suite 345
Fridley, MN 55432-2765

Mailing address

500 Osborne Rd NE
Suite 345
Fridley, MN 55432-2765
Phone (763) 786-4260

National Provider Directory

National Provider Directory
Tax ID family
Metropolitan Pediatric Dental Associates LTD5 organizations share this tax ID, including this one
Part of
Metropolitan Pediatric Dental Associates LTD

Other organizations with this tax ID 4

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

Locations

500 Osborne Rd NE
Ste 345
Fridley, MN 55432
Phone (763) 786-4260

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1730238767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 OSBORNE RD NE",
            "address_2": "SUITE 345",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322765",
            "telephone_number": "763-786-4260",
            "fax_number": "651-224-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 OSBORNE RD NE",
            "address_2": "SUITE 345",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322765",
            "telephone_number": "763-786-4260",
            "fax_number": "651-224-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD",
        "enumeration_date": "2007-01-09",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "NICKMNA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-224-4969",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.