ROCHESTER PEDIATRIC DENTISTRY LLC NPI 1609272822

NPI Information

NPI: 1609272822
Provider Name: ROCHESTER PEDIATRIC DENTISTRY LLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 24D0866032

Address:
1705 S BORADWAY AVE STE B
ROCHESTER, MN
ZIP 55904
Phone: (507) 288-0102
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ROCHESTER PEDIATRIC DENTISTRY LLC is a dental clinic center in Rochester, MN. ROCHESTER PEDIATRIC DENTISTRY LLC NPI is 1609272822. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1705 S BORADWAY AVE STE B
ROCHESTER, MN
ZIP 55904-960
Phone: (507) 288-0102
Fax: (507) 252-1445

The provider's authorized official is Kelly Amanda Jones .
The authorized official title is Pediatric Dentist, Owner and has the following contact phone number (608) 206-1233.

The CLIA number assigned to this NPI record is 24D0866032 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/16/2014 and was last updated on 12/8/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry			No
2	1223P0221X	Dentist	Pediatric Dentistry	D13120	MINNESOTA	No
3	261QD0000X	Clinic/Center	Dental			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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