Amanda Marie Kapetanakis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14918 Issued in MN

Practice address

580 Woodbury Dr Ste 300
Woodbury, MN 55125-4949

Phone

(651) 731-1010

NPI assigned

Jun 20, 2023

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

State licenses

Practice roles

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 Smiles Dentistry, PC

  • Dentist
  • Woodbury, MN
  • NPI 1548659824
  NPD (past)

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1932884764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 WOODBURY DR STE 300",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 WOODBURY DR STE 300",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254949",
            "telephone_number": "651-731-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPETANAKIS",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Henna Kalsi, M.D.
• Shehla A Kamal, MBBS
• Sara Spear Kaminski, O.D.
• Kristi Marie Kamish-Bushinski, MA, LMFT
• Ammon K Kaopua, DDS
• Kiah Kapitan
• Jodi M Kapla Mason, LAC MT(ASCP)
• Richard G Karlen, MD
• Jill P Karnes, MSE, CCC-SLP
• Jessica Renee Karoff

• General Practice Dentistry in Woodbury, MN
• Providers in Woodbury, 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 Jun 20, 2023; 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.