Individual provider Active NPI

Joanna Christine Bourain, DDS

  • Dentist
  • Cottage Grove, MN
National Provider Identifier
1003482217
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D14545 Issued in MN
Practice address
6936 Pine Arbor Dr S Ste 210
Cottage Grove, MN 55016-4672
Phone
(217) 540-8386
NPI assigned
May 28, 2021
Last updated
Oct 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D14545 MN Primary

Addresses

Primary practice location

6936 Pine Arbor Dr S Ste 210
Cottage Grove, MN 55016-4672

Mailing address

6936 Pine Arbor Dr S Ste 210
Cottage Grove, MN 55016-4672
Phone (805) 729-0090

Other practice location 1

1313 Penn Ave N
Minneapolis, MN 55411-3047
Phone (805) 729-0090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211027001937 MN Practitioner - Dentist 1759779515 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin County CurrentSince Jul 12, 2021 Accepting new patients
Hennepin County Current Accepting new patients
Hennepin County CurrentSince Jul 12, 2021 Accepting new patients

Locations

1313 Penn Ave N
Minneapolis, MN 55411
Phone (612) 302-4600

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1003482217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6936 PINE ARBOR DR S STE 210",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164672",
            "telephone_number": "805-729-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6936 PINE ARBOR DR S STE 210",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164672",
            "telephone_number": "217-540-8386"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1313 Penn Ave N",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554113047",
            "country_code": "US",
            "telephone_number": "805-729-0090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURAIN",
        "first_name": "JOANNA",
        "middle_name": "CHRISTINE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-28",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottage Grove, MN

Sources for this page

Verify at the official NPI Registry.