NPIMap

Organization Active NPI

Family & Cosmetic Gentle Dentistry, LTD

  • General Practice Dentistry
  • Plymouth, MN
National Provider Identifier
1750563227
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAMILY & COSMETIC GENTLE DENTISTRY, LTD
Practice address
13550 26TH Ave N Ste 200
Plymouth, MN 55441-3650
Phone
(763) 557-0287
Fax
(763) 557-0295
NPI assigned
Nov 27, 2007
Last updated
Jun 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY & COSMETIC GENTLE DENTISTRY, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Diana Gavic
Title
Operations Manager
Phone
(952) 224-9771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

13550 26TH Ave N Ste 200
Plymouth, MN 55441-3650

Mailing address

6600 France Ave S
415
Edina, MN 55435-1805
Phone (952) 224-9771

Other identifiers 1

IdentifierTypeStateIssuer
190110900MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Family and Cosmetic Gentle Dentistry16 organizations share this tax ID, including this one
Part of
Family and Cosmetic Gentle Dentistry

Other organizations with this tax ID 15

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

View all 15

Locations

13550 26th Ave N
Ste 200
Plymouth, MN 55441
Phone (763) 557-0287

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1750563227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S",
            "address_2": "415",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351805",
            "telephone_number": "952-224-9771",
            "fax_number": "952-224-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13550 26TH AVE N STE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413650",
            "telephone_number": "763-557-0287",
            "fax_number": "763-557-0295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & COSMETIC GENTLE DENTISTRY, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY & COSMETIC GENTLE DENTISTRY, LTD",
        "enumeration_date": "2007-11-27",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "GAVIC",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "952-224-9771"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "190110900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.