MANKATO FAMILY DENTAL, P.A. (NPI# 1912013640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912013640 |
| Entity Type | Organization |
| Organization Name | MANKATO FAMILY DENTAL, P.A. |
| Other Organization Name | BROAD STREET FAMILY DENTAL |
| Practice Address |
151 St Andrews Ct Ste 1120 Mankato MN 56001 |
| Practice Telephone | 5073454259 |
| Practice Fax Number | 5073454460 |
| Mailing Telephone | 5073454259 |
| Mailing Fax Number | 5073454460 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2016-05-03 |
| Authorized Official Name | CHRISTOPHER KELLY MEEHAN (DDS/OWNER) |
| Authorized Official Telephone | 5073454259 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
12148 | MN | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
10009 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | INDIVIDUAL UNDER CORPORAT | 1285610022 | 01 |
| MN | OTHER PROVIDER UNDER CORP | 1770572877 | 01 |
| Other Name | Type Code |
|---|---|
| Broad Street Family Dental | Former Legal Business Name - Organization |
| Street Address |
151 ST ANDREWS CT STE 1120 |
| City | MANKATO |
| State | MN |
| Zip Code | 56001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154935435 | Kelly Nicole Ricke | Physical Medicine & Rehabilitation | 1 Civic Center Plaza, Hockey Office Complex, Mankato, MN 56001 | 2020-09-03 |
| 1649816786 | Ashley Lynn Walters | Technician, Other | 501 Madison Ave., Mankato, MN 56001 | 2019-11-25 |
| 1720631716 | Dovetail Traslation LLC | Interpreter | 212 Dublin Ct, Same As Above, Mankato, MN 56001 | 2019-07-19 |
| 1093377871 | Lindsey Keithahn | Counselor | 2100 Bassett Drive, Mankato, MN 56001 | 2019-07-02 |
| 1255803813 | Amy Marie Williams | Acupuncturist | 709 S. Front Street, Suite 5, Mankato, MN 56001 | 2018-12-20 |
| 1518437573 | Ashley Blanchard | Acupuncturist | Vida Salon Suites 1351 Madison Avenue, Suite F/ Suite 206, Mankato, MN 56001 | 2018-12-03 |
| 1831687235 | Christian Goetz | Specialist/Technologist | 401-477 South Rd, Mankato, MN 56001 | 2018-05-01 |
| 1366949141 | Minnesota State College and Universities | Specialist/Technologist | 135 Myers Field House, Mankato, MN 56001 | 2018-04-09 |
| 1780191775 | Kevin David Nelson | Pharmacist | 111 Redtail Ct Apt 308, Mankato, MN 56001 | 2017-12-29 |
| 1972014231 | Rylee Wagner | Speech-Language Pathologist | Mankato Clinic Pediatric Therapy Services, 150 St. Andrews Court, Suite 310, Mankato, MN 56001 | 2017-10-13 |
| Find all providers in zip 56001 | ||||
| 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 |
|---|---|---|---|---|
| 1043706211 | Katie Sonnabend | Dentist | 608 Madison Ave, Mankato, MN 56001-6112 | 2018-07-10 |
| 1851808653 | Saron Dental Pllc | Dentist | 1880 Tailwind Dr Ste 200, Mankato, MN 56001-6277 | 2018-01-03 |
| 1346525631 | Westwood Family Dental, P.C. | Dentist | 151 Saint Andrews Court, Suite 1110, Mankato, MN 56001 | 2011-10-18 |
| 1164545463 | Daniel M. Osdoba | Dentist | 1550 Adams St, Mankato, MN 56001-5192 | 2007-04-09 |
| 1366563553 | Keir Bruce Townsend | Dentist | 601 N Victory Dr, Mankato, MN 56001-5223 | 2007-04-03 |
| 1992845267 | James Robert Simpson | Dentist | 151 Saint Andrews Court, Suite 1110, Mankato, MN 56001 | 2007-02-07 |
| 1588728885 | John Mark Anderson | Dentist | 530 W Pleasant St, Mankato, MN 56001-0438 | 2006-12-20 |
| 1780691048 | James Joseph Kalina | Dentist | 204 Star St, Mankato, MN 56001-4825 | 2006-08-01 |
| 1053331959 | Gary James Stranik | Dentist | 1600 E Madison Ave, Suite 106, Mankato, MN 56001-5470 | 2006-07-20 |
| 1750361754 | John W Bleecker | Dentist | 123 N Commercial, Mankato, KS 66956 | 2006-01-18 |
| Find all providers in MANKATO | ||||
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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.