Plymouth Dental Care PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7115 Issued in MN

Legal business name

PLYMOUTH DENTAL CARE PC

Practice address

4000 Annapolis LN N
Suite 103
Plymouth, MN 55447-5480

Phone

(763) 551-0501

Fax

(612) 573-6687

NPI assigned

Jun 15, 2007

Last updated

Aug 22, 2020By 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. P. Louis Michelich, D.D.S.

Title

President

Phone

(763) 551-0501

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Peter Louis Michelich, D.D.S.

  • General Practice Dentistry
  • Plymouth, MN
  • NPI 1649352501
  NPD (past)

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730384280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 ANNAPOLIS LN N",
            "address_2": "SUITE 103",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475480",
            "telephone_number": "763-551-0501",
            "fax_number": "612-573-6687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 ANNAPOLIS LN N",
            "address_2": "SUITE 103",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475480",
            "telephone_number": "763-551-0501",
            "fax_number": "612-573-6687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MICHELICH",
        "authorized_official_first_name": "P.",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-551-0501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D7115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pinnacle Dermatology, SC
• Jessica L. Pishney, PSYD, LP
• Laron Ploederer, D.C.
• Jacob Plummer
• Plymouth Chirocenter LLC
• Plymouth Family Dentistry, LLC (Four Seasons Family Dentistry)
• Plymouth Grove Chiropractic, P.a.
• Plymouth Orthopedic Surgery Center LLC (Plymouth Orthopedic Surgery Center)
• Plymouth Plaza Dental
• Plymouth Psych Group, LLC

• General Practice Dentistry in Plymouth, MN
• Providers in Plymouth, 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 Aug 22, 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.