Northstar Dental Clinic PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10615 Issued in MN

Legal business name

NORTHSTAR DENTAL CLINIC PA

Practice address

675 E Nicollet Blvd
Suite 120
Burnsville, MN 55337-6741

Phone

(952) 892-7700

Fax

(952) 892-7767

NPI assigned

May 24, 2006

Organization subpart

No

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

Authorized official

Name

Michael Shawn Nanne, DDS

Title

Owner President

Phone

(952) 892-7700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043265481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 E NICOLLET BLVD",
            "address_2": "SUITE 120",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553376741",
            "telephone_number": "952-892-7700",
            "fax_number": "952-892-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 E NICOLLET BLVD",
            "address_2": "SUITE 120",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553376741",
            "telephone_number": "952-892-7700",
            "fax_number": "952-892-7767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR DENTAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NANNE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SHAWN",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "952-892-7700",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Edward Novak, D.C.

• General Practice Dentistry in Burnsville, MN
• Providers in Burnsville, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.