Prairie Dental Group
NPI 1104057975ActiveOrganization· Dentist, General Practice· Eden Prairie, MN
Dentist, General Practice in Eden Prairie, Minnesota, registered in NPPES in July 2009. The authorized official on file is Caryl Leach, Administrator.
Overview
| NPI | 1104057975 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 28, 2009 |
| Last updated in NPPES | Jul 28, 2009 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | — | — |
| Dentist, Oral and Maxillofacial Surgery | 1223S0112X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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