EDGAR MANTILLA (NPI# 1538177944) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538177944 |
| Entity Type | Individual |
| Full Name | EDGAR MANTILLA |
| Credential | DDS |
| Practice Address |
2001 Bloomington Ave S Minneapolis MN 55404-3074 |
| Practice Telephone | 6123013433 |
| Practice Fax Number | 6126274205 |
| Mailing Telephone | 6123013433 |
| Mailing Fax Number | 6126274205 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2014-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D11889 | MN | Dental Providers |
| Street Address |
2001 BLOOMINGTON AVE S |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55404-3074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326054388 | Michael K Popkin | Psychiatry & Neurology | 2001 Bloomington Ave S, Minneapolis, MN 55404-1210 | 2006-07-31 |
| 1629216247 | Elizabeth Johnson Eggers Rattner | Registered Nurse | 2001 Bloomington Ave S, Minneapolis, MN 55404-3089 | 2009-02-04 |
| 1538177035 | Margaret Camille Larson | Social Worker | 2001 Bloomington Ave S, Community-university Health Care Center, Minneapolis, MN 55404-3074 | 2006-08-03 |
| 1801804422 | Barbara Gershan | Nurse Practitioner | 2001 Bloomington Ave S, Community-university Health Care Center, Minneapolis, MN 55404-3074 | 2006-08-03 |
| 1871501494 | Joseph M. Grayden | Dentist | 2001 Bloomington Ave S, Community-university Health Care Center, Minneapolis, MN 55404-3074 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568062461 | Andrew Moe | Counselor | 2118 Blaisdell Ave S., Minneapolis, MN 55404 | 2020-10-29 |
| 1194368191 | Luz Angelica Fehn Salinas | Psychologist | 1315 E24th St, Minneapolis, MN 55404 | 2019-10-22 |
| 1760969125 | Bethany Karen Kenny | Registered Nurse | 910 E 26th St Ste 200, Minneapolis, MN 55404 | 2018-07-27 |
| 1225535701 | Karissa Dougherty | Nurse Practitioner | 2200 E Franklin Ave # 199, Minneapolis, MN 55404 | 2018-04-10 |
| 1891299491 | Guidance Home Health Care LLC | Home Health | 2529 Nicollet Avenue 202b, Minneapolis, MN 55404 | 2018-03-20 |
| 1770085490 | Bright Future Counseling Service, LLC | Counselor | 912 E. 24th St., Suite B215, Minneapolis, MN 55404 | 2018-03-08 |
| 1346754298 | Juba Pharmacy Inc | Pharmacy | 1926 Chicago Ave S, Minneapolis, MN 55404 | 2017-11-29 |
| 1629597323 | Kira Larson Fieldstrom | Social Worker | 2400 Blaisdell Ave., Minneapolis, MN 55404 | 2017-09-13 |
| 1770008930 | Nicole Lynn Sparks | Social Worker | 2445 Park Avenue, Minneapolis, MN 55404 | 2017-08-09 |
| 1639612765 | Cosmo Home Healthcare Services, L.L.C. | Home Health | 2219 Oakland Ave S, Suite 104, Minneapolis, MN 55404 | 2016-11-21 |
| Find all providers in zip 55404 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679182687 | Downtown Dental Center Pllc | Dentist | 825 Nicollet Mall Ste 1427, Minneapolis, MN 55402-2703 | 2020-07-26 |
| 1205444791 | Patrick Reilly Steck | Dentist | 4948 S 34th Ave, Minneapolis, MN 55417 | 2020-07-21 |
| 1124684725 | Eric James Holthaus | Dentist | 825 Nicollet Ave #1025, Minneapolis, MN 55402 | 2019-05-20 |
| 1154811404 | Mohamed Mukhtar Ali | Dentist | 4700 Cedar Ave S, Minneapolis, MN 55407 | 2018-05-12 |
| 1154828283 | Ari Michael Lederman | Dentist | 825 Nicollet Mall Ste 425, Minneapolis, MN 55402-2608 | 2018-04-05 |
| 1730604877 | Daryl Grigsby Jr. | Dentist | 515 Delaware St Se # 8-166, Minneapolis, MN 55455-0357 | 2017-08-10 |
| 1033630371 | Margaret Elizabeth Craven | Dentist | 250 2nd Ave S Ste 250, Minneapolis, MN 55401-2173 | 2017-06-27 |
| 1013330661 | Helen Oboro-onuora | Dentist | 606 24th Ave S Suite 200, Umphysicians Dental Clinic, Minneapolis, MN 55454 | 2014-01-31 |
| 1548690001 | Patrick J. Foy Dds,pa | Dentist | 606 24th Ave S Ste 806, Minneapolis, MN 55454-1438 | 2013-11-20 |
| 1659719078 | Deanna Miller | Dentist | 3428 20th Ave S, Minneapolis, MN 55407-2408 | 2013-06-07 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55404 |
Please comment or provide details below to improve the information on EDGAR MANTILLA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.