NPIMap

Organization Active NPI

Community Dental Care Inc

Doing business as Community Dental Care

  • Dentist
  • Maplewood, MN
National Provider Identifier
1003886383
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
460668000 Issued in MN
Legal business name
COMMUNITY DENTAL CARE INC
Doing business as
Community Dental Care
Practice address
600 Carlton Street N
Maplewood, MN 55119
Phone
(651) 774-2959
Fax
(651) 774-1997
NPI assigned
Jan 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Authorized official

Name
Dr. Kori C Carlson
Title
HR Director
Phone
(651) 925-8427

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 460668000 MN Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

600 Carlton Street N
Maplewood, MN 55119

Mailing address

1670 Beam Ave
Maplewood, MN 55109
Phone (651) 925-8400

Other identifiers 1

IdentifierTypeStateIssuer
460668000MedicaidMN

Other names 1

  • Community Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

600 Carlton St N
Maplewood, MN 55119
Phone (651) 774-2959

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1003886383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "55109",
            "telephone_number": "651-925-8400",
            "fax_number": "651-925-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 CARLTON STREET N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "55119",
            "telephone_number": "651-774-2959",
            "fax_number": "651-774-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY DENTAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-26",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "KORI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "651-925-8427",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "460668000",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "460668000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.