NPIMap

Organization Active NPI

Northland Dental Partners, PLLC

  • General Practice Dentistry
  • Blaine, MN
National Provider Identifier
1144978560
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NORTHLAND DENTAL PARTNERS, PLLC
Practice address
4255 Pheasant Ridge Dr NE Ste 407
Blaine, MN 55449-5066
Phone
(763) 225-6100
NPI assigned
Mar 15, 2022
Organization subpart
Yes
Parent organization
NORTHLAND DENTAL PARTNERS, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4255 Pheasant Ridge Dr NE Ste 407
Blaine, MN 55449-5066

Mailing address

4255 Pheasant Ridge Dr NE Ste 407
Blaine, MN 55449-5066
Phone (763) 225-6100

Other names 1

  • Metro Dentalcare Blaine Pheasant Ridge Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northland Dental Partners43 organizations share this tax ID, including this one
Part of
Northland Dental Partners

Other organizations with this tax ID 42

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

View all 42

Locations

4255 Pheasant Ridge Dr NE
Ste 407
Blaine, MN 55449
Phone (763) 225-6100

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1144978560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 PHEASANT RIDGE DR NE STE 407",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495066",
            "telephone_number": "763-225-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 PHEASANT RIDGE DR NE STE 407",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495066",
            "telephone_number": "763-225-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND DENTAL PARTNERS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHLAND DENTAL PARTNERS, PLLC",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "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": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metro Dentalcare Blaine Pheasant Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.