NPIMap

Organization Active NPI

Tonka Smiles

  • Dentist
  • Minnetonka, MN
National Provider Identifier
1780790881
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8734 Issued in MN
Legal business name
TONKA SMILES
Practice address
11601 Minnetonka Mills Rd
Ste D40
Minnetonka, MN 55305
Phone
(952) 938-8533
Fax
(952) 938-9321
NPI assigned
Aug 22, 2006
Last updated
Jul 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Authorized official

Name
Dr. Timothy M Bergsteadt, DDS
Title
Owner Dentist
Phone
(952) 938-8533

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 8734 MN Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 10769 MN
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 11571 MN

Addresses

Primary practice location

11601 Minnetonka Mills Rd
Ste D40
Minnetonka, MN 55305

Mailing address

11601 Minnetonka Mills Rd
Ste D40
Minnetonka, MN 55305
Phone (952) 938-8533

Other identifiers 3

IdentifierTypeStateIssuer
056216500MedicaidMN
168135400MedicaidMN
773218000MedicaidMN

Other names 1

  • Axel Bergstedt and Johnson PA Former legal business name

National Provider Directory

National Provider Directory

Locations

11601 Minnetonka Mills Rd
Ste D40
Minnetonka, MN 55305
Phone (952) 938-8533

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": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1780790881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11601 MINNETONKA MILLS RD",
            "address_2": "STE D40",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "55305",
            "telephone_number": "952-938-8533",
            "fax_number": "952-938-9321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11601 MINNETONKA MILLS RD",
            "address_2": "STE D40",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "55305",
            "telephone_number": "952-938-8533",
            "fax_number": "952-938-9321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TONKA SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "BERGSTEADT",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "952-938-8533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "8734",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "10769",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "11571",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056216500",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168135400",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "773218000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Axel Bergstedt and Johnson PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.