NPIMap

Organization Active NPI

Metropolitan Pediatric Dental Associates, LTD

  • Pediatric Dentistry
  • Saint Paul, MN
National Provider Identifier
1861654477
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD
Practice address
1021 Bandana Blvd E
Suite 121
Saint Paul, MN 55108-5113
Phone
(651) 224-4969
Fax
(653) 223-8047
NPI assigned
Jun 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
James D Nickman, DDS
Title
President
Phone
(651) 224-4969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1021 Bandana Blvd E
Suite 121
Saint Paul, MN 55108-5113

Mailing address

1021 Bandana Blvd E
Suite 121
Saint Paul, MN 55108-5113
Phone (651) 224-4969

National Provider Directory

National Provider Directory
Tax ID family
Metropolitan Pediatric Dental Associates LTD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1861654477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 BANDANA BLVD E",
            "address_2": "SUITE 121",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085113",
            "telephone_number": "651-224-4969",
            "fax_number": "653-223-8047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 BANDANA BLVD E",
            "address_2": "SUITE 121",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085113",
            "telephone_number": "651-224-4969",
            "fax_number": "653-223-8047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROPOLITAN PEDIATRIC DENTAL ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-26",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "NICKMAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-224-4969",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; 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.