SOUTHERN HEIGHTS DENTAL GROUP PA NPI 1932247921

NPI Information

NPI: 1932247921
Provider Name: SOUTHERN HEIGHTS DENTAL GROUP PA
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
1575 20TH STREET NORTHWEST
SUITE 102
FARIBAULT, MN
ZIP 55021
Phone: (507) 334-6433
Get Directions

SOUTHERN HEIGHTS DENTAL GROUP PA is a general practice dentist in Faribault, MN. The provider is 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. SOUTHERN HEIGHTS DENTAL GROUP PA NPI is 1932247921. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1575 20TH STREET NORTHWEST
SUITE 102
FARIBAULT, MN
ZIP 55021
Phone: (507) 334-6433
Fax: (507) 334-0044

The provider's authorized official is Kate Tonjum .
The authorized official title is Administrator and has the following contact phone number (507) 334-6433.

The enumeration date for this NPI number is 2/2/2007 and was last updated on 8/6/2020.

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	1223G0001X	Dentist	General Practice	D9884	MINNESOTA	No
2	1223G0001X	Dentist	General Practice	D10323	MINNESOTA	No
3	1223G0001X	Dentist	General Practice	D11586	MINNESOTA	No
4	1223G0001X	Dentist	General Practice	D11400	MINNESOTA	No
5	1223G0001X	Dentist	General Practice	D11631	MINNESOTA	No
6	1223G0001X	Dentist	General Practice	D8742	MINNESOTA	No
7	261QD0000X	Clinic/Center	Dental	D7800	MINNESOTA	No
8	261QD0000X	Clinic/Center	Dental	D13095	MINNESOTA	No
9	1223G0001X	Dentist	General Practice	D7800	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	443655000	MEDICAID	MINNESOTA
2	607320400	MEDICAID	MINNESOTA
3	849698600	MEDICAID	MINNESOTA
4	325522100	MEDICAID	MINNESOTA
5	550722700	MEDICAID	MINNESOTA
6	856415900	MEDICAID	MINNESOTA
7	284735300	MEDICAID	MINNESOTA
8	148427300	MEDICAID	MINNESOTA
9	440217100	MEDICAID	MINNESOTA

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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