Minnesota Craniofacial Center P.C.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

11715 Issued in MN

Legal business name

MINNESOTA CRANIOFACIAL CENTER P.C.

Practice address

2550 University Ave W
Suite 143N
Saint Paul, MN 55114-1052

Phone

(651) 642-1013

Fax

(651) 642-0947

NPI assigned

Nov 26, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Kim Marie Ledermann, D.D.S.

Title

Dentist/Owner

Phone

(651) 642-1013

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1353888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1104160480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W",
            "address_2": "SUITE 143N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141052",
            "telephone_number": "651-642-1013",
            "fax_number": "651-642-0947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W",
            "address_2": "SUITE 143N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141052",
            "telephone_number": "651-642-1013",
            "fax_number": "651-642-0947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA CRANIOFACIAL CENTER P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-26",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "LEDERMANN",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "651-642-1013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "11715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Minneosta Wellness Center LLC
• Minnesota Carepartner, LLC
• Minnesota Center for Psychology, LLC
• Minnesota Chiropractic Center, PA
• Minnesota Craniofacial Center Midway, P.a.
• Minnesota Department of Health
• Minnesota Doc
• Minnesota Foot and Ankle Clinic P a
• Minnesota Hand Rehabilitation Inc
• Minnesota Head and Neck Pain Clinic, PA

• Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.