GUSTAVO PENA-VELASCO (NPI# 1851346639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851346639 |
| Entity Type | Individual |
| Full Name | GUSTAVO PENA-VELASCO |
| Credential | D.D.S., M.S. |
| Practice Address |
3950 Veterans Dr Suite 100 Saint Cloud MN 56303-3410 |
| Practice Telephone | 3202523611 |
| Practice Fax Number | 3202527574 |
| Mailing Telephone | 3202523611 |
| Mailing Fax Number | 3202527574 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2011-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D10925 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 976017200 | 05 |
| Street Address |
3950 VETERANS DR SUITE 100 |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-3410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144547365 | Michael Jerome Schiff | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2010-04-27 |
| 1316133762 | Centrasota Eye Care, Inc | Optometrist | 3950 Veterans Dr, Suite 103, Saint Cloud, MN 56303-3410 | 2007-09-19 |
| 1669539060 | Sharon Kay Lorton | Optometrist | 3950 Veterans Dr, 3950 Veterans Dr., Saint Cloud, MN 56303-3410 | 2007-01-03 |
| 1902843683 | Robert J Keck | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-06-01 |
| 1932156387 | Eric Stine | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-30 |
| 1780639682 | Harold Machesky | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-23 |
| 1003861865 | Donald M. Primley | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-23 |
| 1598710477 | Centrasota Oral & Maxillofacial Surgeons, P.a. | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-22 |
| 1932152154 | Robert Wm Congdon | Dentist | 3950 Veterans Dr, #101, Saint Cloud, MN 56303-3424 | 2006-05-18 |
| 1518910504 | Scott E Stamp Dds Pllc Robert W Congdon Dmd | Dentist | 3950 Veterans Dr, #101, Saint Cloud, MN 56303-3424 | 2006-05-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| 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 |
|---|---|---|---|---|
| 1326255241 | Ryan D Morris | Dentist | 3950 Veterans Dr Ste 100, Saint Cloud, MN 56303-3424 | 2007-05-17 |
| 1497162358 | Nicholas Ryan Kenning | Dentist | 3950 Veterans Dr Ste 100, Saint Cloud, MN 56303-3424 | 2014-07-11 |
| 1033477492 | Sean Philip Welander | Dentist | 3950 Veterans Dr Ste 100, Saint Cloud, MN 56303-3424 | 2012-04-23 |
| 1144547365 | Michael Jerome Schiff | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2010-04-27 |
| 1902843683 | Robert J Keck | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-06-01 |
| 1932156387 | Eric Stine | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-30 |
| 1780639682 | Harold Machesky | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-23 |
| 1003861865 | Donald M. Primley | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-23 |
| 1598710477 | Centrasota Oral & Maxillofacial Surgeons, P.a. | Dentist | 3950 Veterans Dr, Suite 100, Saint Cloud, MN 56303-3410 | 2006-05-22 |
| 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 | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
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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.