NPIMap

Organization Active NPI

Brooklyn Blvd. Dental

  • Health Maintenance Organization
  • Brooklyn Center, MN
National Provider Identifier
1932373032
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
BROOKLYN BLVD. DENTAL
Practice address
5831 Brooklyn Blvd
Brooklyn Center, MN 55429-2521
Phone
(763) 533-8669
Fax
(763) 533-8716
NPI assigned
Apr 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. William Sam Kotonias, D.D.S.NPI 1265655963
Title
Dentist/Owner
Phone
(763) 533-8669

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X MN Primary

Addresses

Primary practice location

5831 Brooklyn Blvd
Brooklyn Center, MN 55429-2521

Mailing address

5831 Brooklyn Blvd
Brooklyn Center, MN 55429-2521
Phone (763) 533-8669

National Provider Directory

National Provider Directory

Locations

5831 Brooklyn Blvd
Minneapolis, MN 55429
Phone (763) 533-8669

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1932373032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5831 BROOKLYN BLVD",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554292521",
            "telephone_number": "763-533-8669",
            "fax_number": "763-533-8716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5831 BROOKLYN BLVD",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554292521",
            "telephone_number": "763-533-8669",
            "fax_number": "763-533-8716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKLYN BLVD. DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KOTONIAS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "SAM",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "763-533-8669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Center, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.