NPIMap

Organization Active NPI

Community Dental Care

  • Point of Service
  • Maplewood, MN
National Provider Identifier
1992102040
Registry record updated Dec 4, 2014
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Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
H9154 Issued in MN
Legal business name
COMMUNITY DENTAL CARE
Practice address
1670 Beam Ave
Maplewood, MN 55109-1201
Phone
(651) 925-8400
NPI assigned
Dec 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Dr. Vacharee Peterson, DDS
Title
Ceo
Phone
(651) 925-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X H9154 MN Primary

Addresses

Primary practice location

1670 Beam Ave
Maplewood, MN 55109-1201

Mailing address

1670 Beam Ave
Maplewood, MN 55109-1201
Phone (651) 925-8400

Other identifiers 1

IdentifierTypeStateIssuer
124Q00000XMedicaidMN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1992102040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091201",
            "telephone_number": "651-925-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091201",
            "telephone_number": "651-925-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "VACHAREE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-925-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MN",
            "license": "H9154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124Q00000X",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.