NPIMap

Organization Active NPI

Jerome Dulac DDS

  • General Practice Dentistry
  • Edina, MN
National Provider Identifier
1811058746
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D6205 Issued in MN
Legal business name
JEROME DULAC DDS
Practice address
6550 York Ave S
#202
Edina, MN 55435-2347
Phone
(952) 925-2176
NPI assigned
Dec 13, 2006
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
Dr. Jerome Dulac, DDSNPI 1598871600
Title
Dentist
Phone
(952) 925-2176

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D6205 MN Primary

Addresses

Primary practice location

6550 York Ave S
#202
Edina, MN 55435-2347

Mailing address

6550 York Ave S
#202
Edina, MN 55435-2347
Phone (952) 925-2176

National Provider Directory

National Provider Directory

Locations

6550 York Ave S
Ste 202
Edina, MN 55435
Phone (952) 925-2176

Practitioners & affiliated clinicians

Practitioners 2

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811058746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 YORK AVE S",
            "address_2": "#202",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352347",
            "telephone_number": "952-925-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 YORK AVE S",
            "address_2": "#202",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352347",
            "telephone_number": "952-925-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME DULAC DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DULAC",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "952-925-2176",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D6205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, 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.