Mankato Family Dental, P.a.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10009 Issued in MN

Legal business name

MANKATO FAMILY DENTAL, P.A.

Practice address

151 St Andrews CT Ste 1120
Mankato, MN 56001

Phone

(507) 345-4259

Fax

(507) 345-4460

NPI assigned

Aug 23, 2006

Last updated

May 3, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christopher Kelly Meehan, DDSNPI 1073740593

Title

DDS/Owner

Phone

(507) 345-4259

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Broad Street Family Dental Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christopher K Meehan, DDS

  • Dentist
  • Mankato, MN
  • NPI 1073740593
  NPD (past) Authorized official
• Bruce G Dumke, DDS

  • General Practice Dentistry
  • Mankato, MN
  • NPI 1285610022
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462233600000",
    "number": "1912013640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 ST ANDREWS CT STE 1120",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-345-4259",
            "fax_number": "507-345-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 ST ANDREWS CT STE 1120",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-345-4259",
            "fax_number": "507-345-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANKATO FAMILY DENTAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2016-05-03",
        "status": "A",
        "authorized_official_last_name": "MEEHAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "KELLY",
        "authorized_official_title_or_position": "DDS/OWNER",
        "authorized_official_telephone_number": "507-345-4259",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "12148",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL UNDER CORPORAT",
            "identifier": "1285610022",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER PROVIDER UNDER CORP",
            "identifier": "1770572877",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broad Street Family Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• General Practice Dentistry in Mankato, MN
• Providers in Mankato, 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 May 3, 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.