NPIMap

Organization Active NPI

Koala Dental Care, LLC

  • Pediatric Dentistry
  • Saint Cloud, MN
National Provider Identifier
1730360355
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
KOALA DENTAL CARE, LLC
Practice address
3950 Veterans Drive
Suite 102
Saint Cloud, MN 56303
Phone
(320) 253-8380
Fax
(320) 253-8419
NPI assigned
Nov 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Dr. John Daivd Collier, DDSNPI 1558385377
Title
Dentist/Owner
Phone
(320) 253-8380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

3950 Veterans Drive
Suite 102
Saint Cloud, MN 56303

Mailing address

3950 Veterans Drive
Suite 102
Saint Cloud, MN 56303
Phone (320) 253-8380

National Provider Directory

National Provider Directory
Tax ID family
Koala Dental Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3950 Veterans Dr
Ste 102
Saint Cloud, MN 56303
Phone (320) 253-8380

1521 Northway Dr
Ste 108
Saint Cloud, MN 56303
Phone (320) 200-2300

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1730360355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 VETERANS DRIVE",
            "address_2": "SUITE 102",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-253-8380",
            "fax_number": "320-253-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 VETERANS DRIVE",
            "address_2": "SUITE 102",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-253-8380",
            "fax_number": "320-253-8419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOALA DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-26",
        "last_updated": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "COLLIER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DAIVD",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "320-253-8380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.