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MIRANDA THACKER DDS
NPI 1710876578
Dentist - Pediatric Dentistry in Minneapolis, MN

Active since June 28, 2025PECOS Enrolled
701 25TH AVE S STE 400, MINNEAPOLIS, MN 55454(612) 626-7232 Get Directions Write a Review

NPPES record last updated: June 28, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Miranda Thacker Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIRANDA THACKER DDS (NPI 1710876578) is an individual pediatric dentistry provider in Minneapolis, Minnesota, licensed in Minnesota (D15303) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1710876578
Entity TypeIndividualFemale
Primary Taxonomy1223P0221X
Provider Legal NameMIRANDA THACKERCredential: DDS
Location Address701 25TH AVE S STE 400Minneapolis, MN 55454-1443
Mailing Address8994 Neill Lake RdEden Prairie, MN 55347-2036
Phone(612) 626-7232
Sole ProprietorYes
Enumeration DateJune 28, 2025
NPPES CertifiedJune 28, 2025
✔ NPI 1710876578 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in MN · D15303
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
701 25TH AVE S STE 400, Minneapolis, MN 55454
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miranda Thacker Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55454 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TAEKHYUN RHEE
Student in an Organized Health Care Education/Training Program
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (612) 659-4900
DR. RYAN PATRICK MCELDOWNEY DMD
Student in an Organized Health Care Education/Training Program
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (612) 626-7232
KYLIE KAREN MULLANEY DDS
Dentist (Pediatric Dentistry)
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (612) 839-7271
JUNHO LEE
Student in an Organized Health Care Education/Training Program
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (612) 659-4900
DR. VARADA SAHASRABUDHE DMD
Dentist (Pediatric Dentistry)
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (612) 659-4900
REGENTS OF THE UNIVERSITY OF MINNESOTA
Dentist (Pediatric Dentistry)
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (612) 626-4232
MOHAMAD ABU SHARKH
Student in an Organized Health Care Education/Training Program
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (519) 659-4900
ALEC CHRISTOPHER GRABINSKI DDS
Dentist (Pediatric Dentistry)
701 25TH AVE S STE 400
MINNEAPOLIS, MN 55454
Hennepin County (612) 659-4900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Miranda Thacker's NPI number?

The NPI number for Miranda Thacker is 1710876578. It was assigned to this individual provider in the NPPES registry on June 28, 2025.

Where is Miranda Thacker located?

Miranda Thacker practices at 701 25th Ave S Ste 400, Minneapolis, MN 55454. The listed phone number is (612) 626-7232.

What is Miranda Thacker's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Miranda Thacker enrolled in Medicare?

Yes. Miranda Thacker is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Miranda Thacker was last updated on June 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.