NPIMap

Organization Active NPI

Otsego Dental

  • Dentist
  • Otsego, MN
National Provider Identifier
1962676825
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D10405 Issued in MN
Legal business name
OTSEGO DENTAL
Practice address
9075 Quaday Ave NE
Suite 101
Otsego, MN 55330-6672
Phone
(763) 441-2452
Fax
(763) 441-7675
NPI assigned
Apr 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Paul Sheils, DDSNPI 1801961073
Title
Dentist/Owner
Phone
(763) 441-2452

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
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D10405 MN Primary

Addresses

Primary practice location

9075 Quaday Ave NE
Suite 101
Otsego, MN 55330-6672

Mailing address

9075 Quaday Ave NE
Suite 101
Otsego, MN 55330-6672
Phone (763) 441-2452

National Provider Directory

National Provider Directory

Locations

9075 Quaday Ave NE
Ste 101
Otsego, MN 55330
Phone (763) 441-2452

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1962676825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9075 QUADAY AVE NE",
            "address_2": "SUITE 101",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553306672",
            "telephone_number": "763-441-2452",
            "fax_number": "763-441-7675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9075 QUADAY AVE NE",
            "address_2": "SUITE 101",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553306672",
            "telephone_number": "763-441-2452",
            "fax_number": "763-441-7675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTSEGO DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "SHEILS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "763-441-2452",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Otsego, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.