St Paul Oral Surgery and Dental Implants LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLC

Practice address

2550 University Ave W Ste 115N
Saint Paul, MN 55114-1097

Phone

(651) 645-6429

Fax

(651) 645-8326

NPI assigned

Jun 17, 2019

Organization subpart

Yes

Parent organization

ST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLCAs reported in NPPES

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

Authorized official

Name

Celia Hayes

Title

Credentialing Coordinator

Phone

(217) 540-2100

Specialties & licenses 1

Addresses

Other names 1

• St. Paul Oral Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St Paul Oral Surgery and Dental Implants LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mendota Heights, MN
  • NPI 1124776687

  O20240202002672

  Same enrollment

Tax ID family

St Paul Oral Surgery and Dental Implants LLC2 organizations share this tax ID, including this one

Part of

St Paul Oral Surgery and Dental Implants LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St Paul Oral Surgery and Dental Implants LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mendota Heights, MN
  • NPI 1124776687
  NPD tax ID

Locations

Practitioners 6

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

• Matthew James Hutchinson, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Paul, MN
  • NPI 1497073969
  NPD
• Levi Zarbano, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Paul, MN
  • NPI 1225458391
  NPD
• Christopher J French, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
  • NPI 1427029073
  NPD (past)
• Travis Allan Johnson, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
  • NPI 1841637295
  NPD (past)
• Charles Joseph Tentinger, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • South St Paul, MN
  • NPI 1528151354
  NPD (past)
• Timothy J Quirt

  • Dentist
  • Schofield, WI
  • NPI 1326251091
  NPD (past)

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1043870645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W STE 115N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141097",
            "telephone_number": "651-645-6429",
            "fax_number": "651-645-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W STE 115N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141097",
            "telephone_number": "651-645-6429",
            "fax_number": "651-645-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLC",
        "enumeration_date": "2019-06-17",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Paul Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Paul Dental Center LLC
• St Paul Eye Clinic PA
• St Paul Eye Clinic PA
• St Paul Family Dentistry
• St Paul Internal Medicine
• St Paul Pharmacy LLC
• St Paul Plastic Surgery LTD
• St Paul Primary Care
• St Paul Ramsey County Dept of Public HLTH
• Jordan St Peter

• Oral and Maxillofacial Surgery (Dentist) in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.