Nicolette Gengel

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14088 Issued in MN

Practice address

1384 109TH Ave NE Ste 200
Blaine, MN 55434

Phone

(763) 757-6000

NPI assigned

May 15, 2017

Last updated

Jul 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blaine Dentistry, PC

  dba Blaine Dentistry

  • General Practice Dentistry
  • Blaine, MN
  • NPI 1982007803
  NPD (past)

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

{
    "created_epoch": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531699200000",
    "number": "1962939546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 LAKE DR S",
            "city": "NEW FAIRFIELD",
            "state": "CT",
            "postal_code": "068123505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1384 109TH AVE NE STE 200",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "55434",
            "telephone_number": "763-757-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Lake Dr S",
            "address_purpose": "LOCATION",
            "city": "New Fairfield",
            "state": "CT",
            "postal_code": "068123505",
            "country_code": "US",
            "telephone_number": "609-306-9838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GENGEL",
        "first_name": "NICOLETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-15",
        "last_updated": "2018-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ben Charles Gailfus
• Fufa Garamo Gaja
• Jesus Galvan-Garcia
• Ashley K Ganser, PA-C
• Joan Gekonde, MD
• Gentle Touch Health Initiatives, LLC (Gentle Touch Health Initiatives)
• John Adrian Gerber, D.C.
• Tetteh Abredu Ghandi
• Brianna Gile
• Abbey Wanette Gitzel, LICSW

• General Practice Dentistry in Blaine, MN
• Providers in Blaine, 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 16, 2018; 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.