Martin A Tahara, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D11409 Issued in MN

Practice address

1701 Curve Crest Blvd W
Suite 108
Stillwater, MN 55082-6044

Phone

(651) 439-8030

Fax

(651) 351-0821

NPI assigned

Jan 23, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• St Croix Oral, Maxillofacial & Implant Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Stillwater, MN
  • NPI 1427129717
  NPD (past)

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1053381061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CURVE CREST BLVD W",
            "address_2": "SUITE 108",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826044",
            "telephone_number": "651-439-8030",
            "fax_number": "651-351-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CURVE CREST BLVD W",
            "address_2": "SUITE 108",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826044",
            "telephone_number": "651-439-8030",
            "fax_number": "651-351-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAHARA",
        "first_name": "MARTIN",
        "middle_name": "A",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D11409",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "5219-015",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33761200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clinton Swenson
• Lyle James Swenson, MD
• Nancy Ann Swenson, DC
• Synertec
• Victoria Tabolich, MS
• Tammy Bydlon Health Consultant
• Kimberly Sue Tatton, NP-C
• Angela Marie Tell
• Stacy Dayandra Tello Castro
• Shoua Theresa Thao Kalugdan, MD

• Oral and Maxillofacial Surgery (Dentist) in Stillwater, MN
• Providers in Stillwater, 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 Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.