NPIMap

Organization Active NPI

Dental Specialist of Minnesota, PLLC

Doing business as The Dental Specialists Roseville PEDS

  • Pediatric Dentistry
  • Roseville, MN
National Provider Identifier
1992307839
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
DENTAL SPECIALIST OF MINNESOTA, PLLC
Doing business as
The Dental Specialists Roseville PEDS
Practice address
1835 County Road C W Ste 290
Roseville, MN 55113-1343
Phone
(651) 501-0018
NPI assigned
Nov 16, 2020
Last updated
Nov 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Shannon Hesse
Title
Credentialing Specialist
Phone
(651) 746-2815

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

1835 County Road C W Ste 290
Roseville, MN 55113-1343

Mailing address

2200 County Road C W Ste 2210
Roseville, MN 55113-2551
Phone (651) 746-2815

Other names 1

  • The Dental Specialists Roseville PEDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Specialists of Minnesota PLLC30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

Organizations that report the same tax identification number in the National Provider Directory.

View all 29

Locations

1835 County Road C W
Ste 290
Roseville, MN 55113
Phone (651) 501-0018

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1992307839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W STE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132551",
            "telephone_number": "651-746-2815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 COUNTY ROAD C W STE 290",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131343",
            "telephone_number": "651-501-0018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SPECIALIST OF MINNESOTA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "651-746-2815"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dental Specialists Roseville PEDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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.