NPIMap

Organization Active NPI

Orthodontic Specialists of Minnesota, P.L.L.C.

Doing business as The Dental Specialists- Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Blaine, MN
National Provider Identifier
1902398944
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
ORTHODONTIC SPECIALISTS OF MINNESOTA, P.L.L.C.
Doing business as
The Dental Specialists- Orthodontics
Practice address
12904 Central Ave NE
Blaine, MN 55434
Phone
(763) 201-6960
NPI assigned
Jun 5, 2018
Last updated
Oct 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Authorized official

Name
John Gulon, DDS
Title
Preseident
Phone
(651) 746-2815

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU Primary

Addresses

Primary practice location

12904 Central Ave NE
Blaine, MN 55434

Mailing address

2200 County Road C W Ste 2210
Roseville, MN 55113-2551
Phone (651) 746-2815

Other names 1

  • The Dental Specialists- Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Orthodontic Specialists of Minnesota PLLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

12904 Central Ave NE
Minneapolis, MN 55434
Phone (763) 201-6960

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1902398944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W STE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132551",
            "telephone_number": "651-746-2815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12904 CENTRAL AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55434",
            "telephone_number": "763-201-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHODONTIC SPECIALISTS OF MINNESOTA, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "GULON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESEIDENT",
        "authorized_official_telephone_number": "651-746-2815",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dental Specialists- Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.