NPIMap

Organization Active NPI

Carl B. Fitzsimmons, DDS, PA

  • Dental Clinic/Center
  • Plymouth, MN
National Provider Identifier
1972894061
Registry record updated Apr 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D11044 Issued in MN
Legal business name
CARL B. FITZSIMMONS, DDS, PA
Practice address
16795 County Road 24
Suite 6
Plymouth, MN 55447-1201
Phone
(763) 577-9840
Fax
(763) 577-9843
NPI assigned
Apr 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2011

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

Authorized official

Name
Dr. Carl Benton Fitzsimmons, D.D.S.NPI 1396846010
Title
President/Ceo
Phone
(763) 577-9840

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
Dental Clinic/Center 261QD0000X D11044 MN Primary

Addresses

Primary practice location

16795 County Road 24
Suite 6
Plymouth, MN 55447-1201

Mailing address

16795 County Road 24
Suite 6
Plymouth, MN 55447-1201
Phone (763) 577-9840

Other names 1

  • Plymouth Station Dental Doing business as

National Provider Directory

National Provider Directory

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": "1303689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303689600000",
    "number": "1972894061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16795 COUNTY ROAD 24",
            "address_2": "SUITE 6",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471201",
            "telephone_number": "763-577-9840",
            "fax_number": "763-577-9843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16795 COUNTY ROAD 24",
            "address_2": "SUITE 6",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471201",
            "telephone_number": "763-577-9840",
            "fax_number": "763-577-9843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARL B. FITZSIMMONS, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-25",
        "last_updated": "2011-04-25",
        "status": "A",
        "authorized_official_last_name": "FITZSIMMONS",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "BENTON",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "763-577-9840",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D11044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plymouth Station Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2011; 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.