NPIMap

Organization Active NPI

Creekview Dental PA

  • Dentist
  • Woodbury, MN
National Provider Identifier
1861463465
Registry record updated Jul 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
MN10688 Issued in MN
Legal business name
CREEKVIEW DENTAL PA
Practice address
2145 Woodlane Dr
Suite 104
Woodbury, MN 55125-1920
Phone
(651) 738-8204
NPI assigned
Jan 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2012

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

Authorized official

Name
Dr. John M Haag, DDSNPI 1750485348
Title
President S Corp
Phone
(651) 738-8204

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X MN10688 MN Primary

Addresses

Primary practice location

2145 Woodlane Dr
Suite 104
Woodbury, MN 55125-1920

Mailing address

2145 Woodlane Dr
Suite 104
Woodbury, MN 55125-1920
Phone (651) 738-8204

National Provider Directory

National Provider Directory

Locations

2145 Woodlane Dr
Ste 104
Woodbury, MN 55125
Phone (651) 738-8204

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": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342483200000",
    "number": "1861463465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2145 WOODLANE DR",
            "address_2": "SUITE 104",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251920",
            "telephone_number": "651-738-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2145 WOODLANE DR",
            "address_2": "SUITE 104",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251920",
            "telephone_number": "651-738-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKVIEW DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2012-07-17",
        "status": "A",
        "authorized_official_last_name": "HAAG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT S CORP",
        "authorized_official_telephone_number": "651-738-8204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "MN10688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.