Active NPI
Mark F Holmberg, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Eden Prairie, MN
National Provider Identifier
1780789743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 9023
- Practice address
- 11800 Singletree LN Ste 406
Eden Prairie, MN 55344-7900 - Phone
- (952) 829-0686
- Fax
- (952) 829-0585
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 9023 | MN | Primary |
Addresses
Primary practice location
11800 Singletree LN Ste 406
Eden Prairie, MN 55344-7900
Mailing address
11800 Singletree LN Ste 406
Eden Prairie, MN 55344-7900
Phone (952) 829-0686
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
| License | State | Type | Specialty |
|---|---|---|---|
| 9023 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780789743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11800 SINGLETREE LN STE 406",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553447900",
"telephone_number": "952-829-0686",
"fax_number": "952-829-0585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11800 SINGLETREE LN STE 406",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553447900",
"telephone_number": "952-829-0686",
"fax_number": "952-829-0585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLMBERG",
"first_name": "MARK",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MN",
"license": "9023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.