NPIMap

Organization Active NPI

Modern Dental Professionals, MN PC

  • General Practice Dentistry
  • Farmington, MN
National Provider Identifier
1770939613
Registry record updated May 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS, MN PC
Practice address
20700 Chippendale Ave W
Suite 10
Farmington, MN 55024-8207
Phone
(651) 315-8229
Fax
(651) 571-0142
NPI assigned
May 10, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2016

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

Authorized official

Name
Elizabeth Rydell, DDS
Title
General Dentist
Phone
(715) 926-5050

Specialties & licenses 1

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

Addresses

Primary practice location

20700 Chippendale Ave W
Suite 10
Farmington, MN 55024-8207

Mailing address

20700 Chippendale Ave W
Suite 10
Farmington, MN 55024-8207
Phone (651) 315-8229

Other names 1

  • Midwest Dental Farmington Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Midwest Dental39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

20700 Chippendale Ave W
Ste 10
Farmington, MN 55024
Phone (651) 315-8229

Practitioners & affiliated clinicians

Practitioners 2

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": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1770939613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20700 CHIPPENDALE AVE W",
            "address_2": "SUITE 10",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550248207",
            "telephone_number": "651-315-8229",
            "fax_number": "651-571-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20700 CHIPPENDALE AVE W",
            "address_2": "SUITE 10",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550248207",
            "telephone_number": "651-315-8229",
            "fax_number": "651-571-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS, MN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-10",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "RYDELL",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "715-926-5050",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental Farmington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.