Active NPI
Ian Timothy Blahnik, DDS
- Dentist
- Roseville, MN
National Provider Identifier
1992367809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14267
- Practice address
- 2690 Snelling Ave N # 250
Roseville, MN 55113-1700 - Phone
- (651) 633-1834
- NPI assigned
- Jul 1, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D14267 | MN | Primary |
Addresses
Primary practice location
2690 Snelling Ave N # 250
Roseville, MN 55113-1700
Mailing address
4831 W 131 1/2 St
Savage, MN 55378-2507
Phone (612) 910-9477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14267 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561939200000",
"number": "1992367809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4831 W 131 1/2 ST",
"city": "SAVAGE",
"state": "MN",
"postal_code": "553782507",
"telephone_number": "612-910-9477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2690 SNELLING AVE N # 250",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551131700",
"telephone_number": "651-633-1834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAHNIK",
"first_name": "IAN",
"middle_name": "TIMOTHY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-01",
"last_updated": "2019-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.