DENTAL SPECIALIST OF MINNESOTA, PLLC (NPI# 1568071199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568071199 |
| Entity Type | Organization |
| Organization Name | DENTAL SPECIALIST OF MINNESOTA, PLLC |
| Practice Address |
18258 Minnetonka Blvd Ste 100 Wayzata MN 55391-3324 |
| Mailing Address |
2200 County Road C W Ste 2210 Roseville MN 55113-2551 |
| Practice Telephone | 9529262761 |
| Mailing Telephone | 6517462815 |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2020-07-29 |
| Authorized Official Name | SHANNON HESSE (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 6517462815 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223E0200X |
Dentist Specialization: Endodontics |
Dental Providers | ||
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers | ||
| N | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers | ||
| N | 1223P0700X |
Dentist Specialization: Prosthodontics |
Dental Providers | ||
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Other Name | Type Code |
|---|---|
| The Dental Specialist Deephaven | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073122321 | Dental Specialist of Minnesota, Pllc | Dentist | 324 W Superior St Ste 824, Duluth, MN 55802-1718 | 2020-07-23 |
| Street Address |
18258 MINNETONKA BLVD STE 100 |
| City | WAYZATA |
| State | MN |
| Zip Code | 55391-3324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386456 | Alexandra Lloyd Conroy | Counselor | 3227 Lake Shore Boulevard, Minnetonka, MN 55391 | 2020-11-07 |
| 1417579178 | Kate Anne Schroeder | Behavioral Analyst | 901 Twelve Oaks Center Drive Suite 934, Wayzata, MN 55391 | 2020-05-15 |
| 1467940478 | Tyler Michael Knutson | Chiropractor | 1421 E Wayzata Blvd, Wayzata, MN 55391 | 2018-04-25 |
| 1427552025 | Emma Nadler, L.L.C. | Counselor | 700 Twelve Oaks Center Dr. #263, Wayzata, MN 55391 | 2018-03-20 |
| 1730687757 | Global Home Care Inc | Home Health | 1001 Twelve Oaks Center Drive, Suite 1018, Wayzata, MN 55391 | 2018-01-24 |
| 1205362472 | Oraphanh Vongpheth Smith | Registered Nurse | 801 Twelve Oaks Center Drive, Suite 822, Wayzata, MN 55391 | 2017-05-10 |
| 1386189272 | Wayzata Endodontics, P.a. | Dentist | 101 Lake Street West, Suite 100, Wayzata, MN 55391 | 2016-12-30 |
| 1952763351 | Watershed Psychological Services | Clinic/Center | 4255 Pheasant Ridge Drive, Suite 412, Blaine, MN 55391 | 2016-03-24 |
| 1477923571 | Robert J. Floren | Marriage & Family Therapist | 801 Twelve Oaks Center Dr Ste 816a, Wayzata, MN 55391 | 2015-10-01 |
| 1194101055 | Bruce Martinson Family & Cosmetic Dentistry | Dentist | 317 E Wayzata Blvd, Wayzata, MN 55391 | 2015-08-03 |
| Find all providers in zip 55391 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265650956 | Oral and Maxillofacial Surgical Consultants Pa | Dentist | 250 Central Ave N, Suite126, Wayzata, MN 55391-1206 | 2007-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982213237 | Yue Hu | Dentist | 515 Delaware St. Se Malcolm Moos Health Sciences Tower, Room 7-174, Minneapolis, MN 55455 | 2020-07-23 |
| 1285294611 | Brian Michael Laing | Dentist | 7-147 Moos Health Science Tower, 515 Delaware Street S.e., Minneapolis, MN 55455-0357 | 2019-06-18 |
| 1295218303 | Advanced Oral Surgery | Dentist | 19925 Idealic Ave, Lakeville, MN 55044-2003 | 2018-09-13 |
| 1205366002 | Derek Miller | Dentist | 7-174 Moos Tower 515 Delaware St. S, U of M Oral Surgery, Minneapolis, MN 55455 | 2017-06-14 |
| 1497113674 | West Lakes Dentistry, Pa | Dentist | 5205 Shoreline Dr, Mound, MN 55364-1770 | 2016-02-03 |
| 1003203498 | Tyler John Varhol | Dentist | 550 County Road D W Ste 12, New Brighton, MN 55112-3517 | 2015-04-23 |
| 1225458391 | Levi Zarbano | Dentist | 2550 University Ave W Ste 115n, Saint Paul, MN 55114-1097 | 2014-04-16 |
| 1154760932 | John Salek-raham | Dentist | 700 Village Center Dr., Ste 170, North Oaks, MN 55127-3025 | 2013-06-14 |
| 1649511585 | Kristopher Lee Hasstedt | Dentist | Dentists of Woodbury, 7150 Valley Creek Plaza Ste #230, Woodbury, MN 55125 | 2013-03-01 |
| 1396095048 | Dental Specialists of Minnesota, Pllc | Dentist | 3360 Northdale Blvd., Coon Rapids, MN 55448-1825 | 2012-09-10 |
| Find all providers with the same taxonomy | ||||
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| 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.