James Gregory Koller, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10366 Issued in MN

Practice address

2534 7TH Ave E
North Saint Paul, MN 55109-3003

Phone

(651) 777-6454

Fax

(651) 773-9206

NPI assigned

Oct 16, 2005

Reactivated

Nov 18, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• James G Koller DDS,PA

  • Dental Clinic/Center
  • North St Paul, MN
  • NPI 1174989743
  NPD Authorized official

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

{
    "created_epoch": "1129420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574035200000",
    "number": "1902895642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 CENTENNIAL DR STE 102",
            "city": "NORTH SAINT PAUL",
            "state": "MN",
            "postal_code": "551093087",
            "telephone_number": "651-777-6454",
            "fax_number": "651-773-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2534 7TH AVE E",
            "city": "NORTH SAINT PAUL",
            "state": "MN",
            "postal_code": "551093003",
            "telephone_number": "651-777-6454",
            "fax_number": "651-773-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "JAMES",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-16",
        "last_updated": "2019-11-18",
        "deactivation_date": "2019-10-31",
        "reactivation_date": "2019-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ntsuab-Ci Khang
• Felicia Kienitz
• Claire Killian
• Rachel Kathleen Kissinger
• Amanda Klipstein
• Shaian Noobnas Kong
• Stephanie Lafavor
• Elizabeth Larson Leier, SLP
• Jesse A Louviere
• Elizabeth Mahady

• General Practice Dentistry in North Saint Paul, MN
• Providers in North Saint Paul, 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 Nov 18, 2019; 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.