DENTAL SPECIALIST OF MINNESOTA, PLLC (NPI# 1073122321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073122321 |
| Entity Type | Organization |
| Organization Name | DENTAL SPECIALIST OF MINNESOTA, PLLC |
| Practice Address |
324 W Superior St Ste 824 Duluth MN 55802-1718 |
| Mailing Address |
2200 County Road C W Ste 2210 Roseville MN 55113-2551 |
| Practice Telephone | 2187271182 |
| Mailing Telephone | 6517462815 |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2020-07-23 |
| 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 | 1223G0001X |
Dentist Specialization: General Practice |
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 Downtown Duluth | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568071199 | Dental Specialist of Minnesota, Pllc | Dentist | 18258 Minnetonka Blvd Ste 100, Wayzata, MN 55391-3324 | 2020-07-29 |
| Street Address |
324 W SUPERIOR ST STE 824 |
| City | DULUTH |
| State | MN |
| Zip Code | 55802-1718 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215588660 | The Dental Specialist of Minnesota, Pllc | Dentist | 324 W Superior St Ste 824, Duluth, MN 55802-1718 | 2019-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063915239 | Jpw Counseling & Consultation | Social Worker | 302 W Superior St Ste 508, Duluth, MN 55802 | 2018-03-14 |
| 1134664311 | Amp Group, LLC | Counselor | 331 West Superior Street, Duluth, MN 55802 | 2016-12-27 |
| 1982151361 | Tiffany Riester | Counselor | 332 W Superior Street, Suite 300, Duluth, MN 55802 | 2016-09-02 |
| 1730635392 | Karina Krosbakken | Counselor | 332 W. Superior St., Suite 300, Duluth, MN 55802 | 2016-09-01 |
| 1437559051 | Natalie R Zwak | Dietitian, Registered | 26 E Superior St Ste 315, Duluth, MN 55802 | 2014-09-02 |
| 1447679279 | Valerie Lou Shelton | Registered Nurse | 118 E Superior St., Duluth, MN 55802 | 2014-04-09 |
| 1285063115 | Brian Bergstedt | Counselor | 332 West Superior Street, Suite 300, Duluth, MN 55802 | 2013-11-01 |
| 1508135948 | Karen Dee Turner | Counselor | 202 W. Superior Street, Suite 700, Duluth, MN 55802 | 2011-12-14 |
| 1497023410 | Jean Barrie Mcbride | Pharmacist | 1131 East Superior Street, Duluth, MN 55802 | 2011-12-05 |
| 1194092304 | Diane Murphy Winship | Pharmacist | 1331 Superior St, Duluth, MN 55802 | 2011-11-17 |
| Find all providers in zip 55802 | ||||
| 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 |
|---|---|---|---|---|
| 1598370454 | Karin Davis, Dmd, PC | Dentist | 3630 Savannah Pl Ste 250, Duluth, GA 30096-6394 | 2020-09-08 |
| 1922193770 | Thomas Richard Seidelmann | Dentist | 1000 E 1st St Ste 302, Duluth, MN 55805-2297 | 2006-10-04 |
| 1801981444 | John Rodman Cornell | Dentist | 1000 East First Street #302, Duluth, MN 55805-2297 | 2006-10-03 |
| 1750475299 | Paul Kevin Hodapp | Dentist | 1000 E 1st St Ste 108, Duluth, MN 55805-2297 | 2006-10-02 |
| 1255505996 | Scott Kenneth Varland | Dentist | 1000 E 1st St Ste 108, Duluth, MN 55805-2297 | 2008-04-14 |
| 1356528558 | Glen C Mcintosh D.d.s., P.C. | Dentist | 3400 Mcclure Bridge Road, Building G Suite B, Duluth, GA 30096 | 2008-01-30 |
| 1407059009 | Joby E. Jaberi | Dentist | 1000 E 1st St, Suite 302, Duluth, MN 55805-2297 | 2007-06-09 |
| 1104976570 | Peter J Mayer | Dentist | 3617 W Arrowhead Rd, Duluth, MN 55811-4046 | 2007-01-10 |
| 1457401820 | Northern Oral & Maxillofacial Surgeons, Pa | Dentist | 3617 W Arrowhead Rd, Duluth, MN 55811-4046 | 2007-01-10 |
| 1679623029 | Charles R Babst | Dentist | 3617 W Arrowhead Rd, Duluth, MN 55811-4046 | 2007-01-10 |
| Find all providers in DULUTH | ||||
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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.