NPIMap

Organization Active NPI

Minnesota Dental Professionals, P.C.

Doing business as Blue Heron Dental Care

  • General Practice Dentistry
  • Lino Lakes, MN
National Provider Identifier
1114781739
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MINNESOTA DENTAL PROFESSIONALS, P.C.
Doing business as
Blue Heron Dental Care
Practice address
601 Apollo Dr Ste 110
Lino Lakes, MN 55014-3020
Phone
(763) 542-3765
NPI assigned
Feb 13, 2024
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HEARTLAND DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

601 Apollo Dr Ste 110
Lino Lakes, MN 55014-3020

Mailing address

601 Apollo Dr Ste 110
Lino Lakes, MN 55014-3020

Other names 1

  • Blue Heron Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Dental Professionals PC23 organizations share this tax ID, including this one
Part of
Minnesota Dental Professionals PC

Other organizations with this tax ID 22

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

View all 22

Locations

601 Apollo Dr
Lino Lakes, MN 55014
Phone (763) 347-2649

601 Apollo Dr
Ste 110
Lino Lakes, MN 55014
Phone (638) 786-4497

NPI Registry JSON

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1114781739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 APOLLO DR STE 110",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550143020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 APOLLO DR STE 110",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550143020",
            "telephone_number": "763-542-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEARTLAND DENTAL",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Heron Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Heron Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lino Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.