Tracy Marie St. Dennis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12517 Issued in MN

Practice address

3475 Willow Lake Blvd Ste 100
Vadnais Heights, MN 55110-5160

Phone

(651) 294-9500

NPI assigned

May 23, 2008

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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1922266295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 WILLOW LAKE BLVD STE 100",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105160",
            "telephone_number": "651-294-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 WILLOW LAKE BLVD STE 100",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105160",
            "telephone_number": "651-294-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST. DENNIS",
        "first_name": "TRACY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-23",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Thomas Simon, OTD, OTR/L
• Emily Christine Smith, MA, BCBA
• Katelyn Jean Smith
• Mary O'Shaughnessy Smith, OTR/L
• Daniel Allen Sonday, MS, ATC, OTC
• Jacqueline A St. John, PA-C
• Andrea Maggie Stankiewicz, DNP, APRN, PMHNP-BC
• Anthony J Sterk, PA-C
• Haley Stewart
• Heather Dawn Stirling, LICSW

• General Practice Dentistry in Vadnais Heights, MN
• Providers in Vadnais Heights, 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 Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.