Merissa Velma Richter Marcussen, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13693 Issued in MN

Practice address

4180 Dean Lakes Blvd
Shakopee, MN 55379-2851

Phone

(952) 233-1020

NPI assigned

Apr 26, 2016

Last updated

Sep 29, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Merissa Velma Richter Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• West End Dental PLLC

  • General Practice Dentistry
  • Minneapolis, MN
  • NPI 1396690863
  NPD Authorized official
• Hunter Creek Dental, PA

  • General Practice Dentistry
  • Montgomery, MN
  • NPI 1124575501
  NPD (past)
• Nancy a Norling DDS PA

  • General Practice Dentistry
  • Minneapolis, MN
  • NPI 1629150008
  NPD (past)
• PDG, P.a

  dba Park Dental Yankee Doodle Road

  • Dental Clinic/Center
  • Eagan, MN
  • NPI 1952952392
  NPD (past)

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

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1891140075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 VAGABOND CT N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554472572",
            "telephone_number": "612-247-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4180 DEAN LAKES BLVD",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792851",
            "telephone_number": "952-233-1020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1660 Highway 100 S Ste 122",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554161483",
            "country_code": "US",
            "telephone_number": "952-544-4129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARCUSSEN",
        "first_name": "MERISSA",
        "middle_name": "VELMA RICHTER",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-26",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MERISSA",
            "last_name": "RICHTER",
            "middle_name": "VELMA",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Dentistry in Shakopee, MN
• Providers in Shakopee, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.