Paul Huyphuoc Thai, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11301 Issued in MN

Practice address

18315 Cascade Dr Ste 120
Eden Prairie, MN 55347-1190

Phone

(952) 949-2536

NPI assigned

Dec 8, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• PDG, P.a.

  dba Park Dental

  • General Practice Dentistry
  • Eden Prairie, MN
  • NPI 1588730527
  NPD (past)

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1952460446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 GRIFFIT ST",
            "city": "HOPKINS",
            "state": "MN",
            "postal_code": "553438411",
            "telephone_number": "612-298-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18315 CASCADE DR STE 120",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553471190",
            "telephone_number": "952-949-2536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAI",
        "first_name": "PAUL",
        "middle_name": "HUYPHUOC",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687684600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Naomi Sarah Teetzel, MAOT
• Joshua Patrick Teich, MD
• Anna Martha Teien
• Temporary Living Center (TLC)
• Daniel Romero Teske, LPCC
• CJ Chuci Thao, PA-C
• The Colony at Eden Prairie
• The Cornerstone MN LLC
• Thedacare Medical Center - Shawano, Inc.
• Thedacare Medical Center - Waupaca, Inc.

• General Practice Dentistry in Eden Prairie, MN
• Providers in Eden Prairie, 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 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.