Michael Manfred Pelke, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11646 Issued in MN

Practice address

215 Radio Dr Ste 201
Saint Paul, MN 55125-5815

Phone

(651) 739-7910

Fax

(651) 739-0611

NPI assigned

Aug 4, 2006

Sex

Male

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

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.

• Woodbury Dental Care

  • Dental Clinic/Center
  • Saint Paul, MN
  • NPI 1790351716
  NPD Authorized official

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1932117769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 201",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551255815",
            "telephone_number": "651-739-7910",
            "fax_number": "651-739-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 201",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551255815",
            "telephone_number": "651-739-7910",
            "fax_number": "651-739-0611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELKE",
        "first_name": "MICHAEL",
        "middle_name": "MANFRED",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Rehabilitation Associates
• Maia Nicole Pedrosa
• Kamber Peerboom, LICSW
• Danielle Marie Peick, NP
• Cora L Peine, PA
• Natalia Pellegrino, ND
• Joshua Jerald Peltier, M.D.
• Steven W Peltier, PH.D., L.P., L.M.F.T
• Kyle Louis Peltola, M.ED., LPCC
• Katherine Marie McDaniels Peltz, PA-C

• General Practice Dentistry in Saint Paul, MN
• Providers in 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 Sep 12, 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.