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

750 Main St Ste 200
Mendota Heights, MN 55118-3767

Phone

(651) 451-1873

Fax

(651) 451-8010

NPI assigned

Mar 14, 2022

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 - Mendota Heights 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)
  • Saint Paul, MN
  • NPI 1043870645

  O20240202002672

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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)
  • Saint Paul, MN
  • NPI 1043870645
  NPD tax ID

Practitioners 2

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
  Medicare reassignment NPD
• Levi Zarbano, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Paul, MN
  • NPI 1225458391
  Medicare reassignment NPD

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

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1124776687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 MAIN ST STE 200",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551183767",
            "telephone_number": "651-451-1873",
            "fax_number": "651-451-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MAIN ST STE 200",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551183767",
            "telephone_number": "651-451-1873",
            "fax_number": "651-451-8010"
        }
    ],
    "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": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Paul Oral Surgery - Mendota Heights",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Marie Soler, RN QP
• Ellyn Ashley Spaeth, OTR/L
• Derrick Spencer
• Luke Phillip Spiegelhoff, LICSW
• Jacqueline Marie Spriggs
• Sara Stamschror
• Reagan Elizabeth Stanchfield
• Helena Elizabeth Stedman Dowler
• Marissa Steele
• Karoline M Steil

• Oral and Maxillofacial Surgery (Dentist) in Mendota Heights, MN
• Providers in Mendota Heights, 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 Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.