NPIMap

Organization Active NPI

St. Cloud Technical College Community Dental Clinic

  • Dentist
  • Saint Cloud, MN
National Provider Identifier
1992821706
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7913 Issued in MN
Legal business name
ST. CLOUD TECHNICAL COLLEGE COMMUNITY DENTAL CLINIC
Practice address
1540 Northway Dr
Saint Cloud, MN 56303-1240
Phone
(320) 308-5310
Fax
(320) 308-5055
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Melissa Lindgren
Title
Clinic Coordinator
Phone
(320) 308-5310

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 7913 MN Primary

Addresses

Primary practice location

1540 Northway Dr
Saint Cloud, MN 56303-1240

Mailing address

1540 Northway Dr
Saint Cloud, MN 56303-1240
Phone (320) 308-5310

National Provider Directory

National Provider Directory
Tax ID family
St Cloud State University27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

1540 Northway Dr
Saint Cloud, MN 56303
Phone (320) 308-5310

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992821706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 NORTHWAY DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031240",
            "telephone_number": "320-308-5310",
            "fax_number": "320-308-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 NORTHWAY DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031240",
            "telephone_number": "320-308-5310",
            "fax_number": "320-308-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLOUD TECHNICAL COLLEGE COMMUNITY DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LINDGREN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CLINIC COORDINATOR",
        "authorized_official_telephone_number": "320-308-5310"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "7913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.