Ideal Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

IDEAL DENTAL PLLC

Practice address

2130 Cliff Rd Ste 107
Eagan, MN 55122-2486

Phone

(651) 452-3112

NPI assigned

Aug 7, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Trent Mitchel Anderson, DDS

Title

Partner/Owner

Phone

(651) 353-6651

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565136000000",
    "number": "1730734708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7810 SAINT CROIX TRAIL LN S",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550339737",
            "telephone_number": "651-353-6651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 CLIFF RD STE 107",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222486",
            "telephone_number": "651-452-3112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2019-08-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "TRENT",
        "authorized_official_middle_name": "MITCHEL",
        "authorized_official_title_or_position": "PARTNER/OWNER",
        "authorized_official_telephone_number": "651-353-6651",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689663148",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Rae Paulsen Hyser, MD
• Nicole Carla Iammatteo
• Muna Ibrahim, BT
• Mustafe Ayube Ibrahim
• Suudi D Ibrahim
• Ideal Homecare, LLC
• Jennifer Ihbe-Eberts
• Patience Imade Ikonagbon
• Ilhc of Eagan, LLC
• Kurt Robert Illig, PHD, LP

• General Practice Dentistry in Eagan, MN
• Providers in Eagan, 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 7, 2019; 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.