Individual provider Active NPI

Caroline Dsouza

  • General Practice Dentistry
  • Minneapolis, MN
National Provider Identifier
1780422972
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D15165 Issued in MN
Practice address
7710 Brooklyn Blvd FL 1
Minneapolis, MN 55443-2979
Phone
(651) 292-9331
NPI assigned
Jul 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D15165 MN Primary

Addresses

Primary practice location

7710 Brooklyn Blvd FL 1
Minneapolis, MN 55443-2979

Mailing address

8164 Evergreen LN N
Maple Grove, MN 55369-3139
Phone (650) 398-9933

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D15165MNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
CLD - Brooklyn Park MN, LLC CurrentSince Jul 21, 2024 Accepting new patients
Ignite Dental PLLC General Practice PastSince Jul 21, 2024 Accepting new patients

Locations

7710 Brooklyn Blvd
Fl 1
Minneapolis, MN 55443
Phone (651) 292-9331

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1721347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1780422972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8164 EVERGREEN LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553693139",
            "telephone_number": "650-398-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7710 BROOKLYN BLVD FL 1",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554432979",
            "telephone_number": "651-292-9331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DSOUZA",
        "first_name": "CAROLINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-19",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D15165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.