Carlos Ernesto Campodonico, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12159 Issued in MN

Practice address

11806 Aberdeen St NE Ste 150
Blaine, MN 55449-4748

Phone

(763) 786-1545

Fax

(763) 786-2939

NPI assigned

Apr 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Campodonico Family & Cosmetic Dentistry PC

  • General Practice Dentistry
  • Blaine, MN
  • NPI 1104249259
  NPD (past) Authorized official
• Killian & Milnar Dentistry PLLC

  • General Practice Dentistry
  • Blaine, MN
  • NPI 1376687103
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470096000000",
    "number": "1154546877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11806 ABERDEEN ST NE STE 150",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494748",
            "telephone_number": "763-786-1545",
            "fax_number": "763-786-2939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11806 ABERDEEN ST NE STE 150",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494748",
            "telephone_number": "763-786-1545",
            "fax_number": "763-786-2939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPODONICO",
        "first_name": "CARLOS",
        "middle_name": "ERNESTO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2016-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767695000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin M Burton, PA
• Erin Marie Burton, PHARMD
• Jennifer Ann Burvee, CNP
• Julia Bynum, OTD
• Campodonico Family & Cosmetic Dentistry PC
• Carefident Health Services
• Careteam Home LLC
• Lauren Carlson, R.D, L.D
• Madeline Grace Carlson
• Emma Jo Carmichael

• General Practice Dentistry in Blaine, MN
• Providers in Blaine, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2016; 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.