Gary Alan Bolmgren, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

9129 Issued in MN

Practice address

381 Southdale Medical Center
6545 France Ave. S.
Edina, MN 55435-2121

Phone

(952) 926-7766

Fax

(952) 926-2037

NPI assigned

Apr 26, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215157631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 SOUTHDALE MEDICAL CENTER",
            "address_2": "6545 FRANCE AVE. S.",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352121",
            "telephone_number": "952-926-7766",
            "fax_number": "952-926-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 SOUTHDALE MEDICAL CENTER",
            "address_2": "6545 FRANCE AVE. S.",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352121",
            "telephone_number": "952-926-7766",
            "fax_number": "952-926-2037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLMGREN",
        "first_name": "GARY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "9129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Lyn Boisjoli, MA, LPCC
• Rebecca Boknevitz, RN
• Heidi Leigh Bolgren, PA-C
• Dmitry Bolkhovets, M.D.
• Abby Christine Bollum, LADC
• Samuel N Bone III, M.D.
• Ramachandra Pras Bongu
• Neil Craig Bonstrom, DDS
• Bridgett Ann Bonte-Chun, DPT
• Chris Peter Boosalis, CERTIFIED PROSTHETIS

• Orthodontics and Dentofacial Orthopedics Dentistry in Edina, MN
• Providers in Edina, MN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.