Active NPI
Ryan William Todorovich, DDS
- Dentist
- Red Wing, MN
National Provider Identifier
1871163402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14602
- Practice address
- 608 Technology Dr
Red Wing, MN 55066-2846 - Phone
- (751) 388-1806
- NPI assigned
- Jun 27, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D14602 | MN | Primary |
Addresses
Primary practice location
608 Technology Dr
Red Wing, MN 55066-2846
Mailing address
11766 177TH St W
Lakeville, MN 55044-5201
Phone (952) 715-0685
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14602 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624752000000",
"number": "1871163402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11766 177TH ST W",
"city": "LAKEVILLE",
"state": "MN",
"postal_code": "550445201",
"telephone_number": "952-715-0685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 TECHNOLOGY DR",
"city": "RED WING",
"state": "MN",
"postal_code": "550662846",
"telephone_number": "751-388-1806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TODOROVICH",
"first_name": "RYAN",
"middle_name": "WILLIAM",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-27",
"last_updated": "2021-06-27",
"certification_date": "2021-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Wing, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.