NPIMap

Organization Active NPI

Family Dental Clinic, P.a.

  • General Practice Dentistry
  • Minneapolis, MN
National Provider Identifier
1861546111
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D7605 Issued in MN
Legal business name
FAMILY DENTAL CLINIC, P.A.
Practice address
4454 Chicago Ave
Minneapolis, MN 55407-3522
Phone
(612) 823-6262
Fax
(612) 823-6783
NPI assigned
Jan 23, 2007
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
Richard Sorenson, D.D.S.NPI 1417002304
Title
President
Phone
(612) 823-6262

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 D7605 MN Primary

Addresses

Primary practice location

4454 Chicago Ave
Minneapolis, MN 55407-3522

Mailing address

4454 Chicago Ave
Minneapolis, MN 55407-3522
Phone (612) 823-6262

National Provider Directory

National Provider Directory

Locations

4454 Chicago Ave
Minneapolis, MN 55407
Phone (612) 823-6262

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": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861546111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4454 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073522",
            "telephone_number": "612-823-6262",
            "fax_number": "612-823-6783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4454 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073522",
            "telephone_number": "612-823-6262",
            "fax_number": "612-823-6783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SORENSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-823-6262",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D7605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, 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.