NPIMap

Organization Active NPI

G2 Dental

  • Dentist
  • Forest Lake, MN
National Provider Identifier
1790776144
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8009 Issued in MN
Legal business name
G2 DENTAL
Practice address
1068 Lake St S
#209
Forest Lake, MN 55025-2639
Phone
(651) 464-2248
Fax
(651) 464-7944
NPI assigned
Nov 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Tracey M Koch
Title
Office Manager
Phone
(651) 464-2248

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 8109 MN
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 8009 MN Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 9975 MN
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 11691 MN

Addresses

Primary practice location

1068 Lake St S
#209
Forest Lake, MN 55025-2639

Mailing address

1068 Lake St S
#209
Forest Lake, MN 55025-2639
Phone (651) 464-2248

National Provider Directory

National Provider Directory

Locations

1068 Lake St S
Ste 209
Forest Lake, MN 55025
Phone (651) 464-2248

Practitioners & affiliated clinicians

Practitioners 4

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": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790776144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 LAKE ST S",
            "address_2": "#209",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252639",
            "telephone_number": "651-464-2248",
            "fax_number": "651-464-7944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 LAKE ST S",
            "address_2": "#209",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252639",
            "telephone_number": "651-464-2248",
            "fax_number": "651-464-7944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G2 DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "651-464-2248",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "8109",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "8009",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "9975",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "11691",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.