NPIMap

Organization Active NPI

Family & Cosmetic Gentle Dentistry

  • General Practice Dentistry
  • Spring Park, MN
National Provider Identifier
1790967248
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAMILY & COSMETIC GENTLE DENTISTRY
Practice address
4787 Shoreline Dr
Spring Park, MN 55384-9713
Phone
(952) 471-0900
Fax
(952) 471-1046
NPI assigned
Nov 27, 2007
Last updated
Jun 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY & COSMETIC GENTLE DENTISTRYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Diana Gavic
Title
Operations Manager
Phone
(952) 224-9771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

4787 Shoreline Dr
Spring Park, MN 55384-9713

Mailing address

6600 France Ave S Ste 415
Edina, MN 55435-1817
Phone (952) 224-9771

Other identifiers 1

IdentifierTypeStateIssuer
318092100MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Family and Cosmetic Gentle Dentistry16 organizations share this tax ID, including this one
Part of
Family and Cosmetic Gentle Dentistry

Other organizations with this tax ID 15

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

View all 15

Locations

4787 Shoreline Dr
Spring Park, MN 55384
Phone (952) 471-0900

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1790967248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 415",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351817",
            "telephone_number": "952-224-9771",
            "fax_number": "952-224-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4787 SHORELINE DR",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849713",
            "telephone_number": "952-471-0900",
            "fax_number": "952-471-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & COSMETIC GENTLE DENTISTRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY & COSMETIC GENTLE DENTISTRY",
        "enumeration_date": "2007-11-27",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "GAVIC",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "952-224-9771"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "318092100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.