Northside Minnesota Oral and Maxillofacial Surgeons, PLLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

NORTHSIDE MINNESOTA ORAL AND MAXILLOFACIAL SURGEONS, PLLC

Practice address

11441 Osage St NW
Coon Rapids, MN 55433-3677

Phone

(763) 862-6442

NPI assigned

Jun 22, 2021

Organization subpart

No

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

Authorized official

Name

Mohamed El Deeb

Title

Owner

Phone

(763) 862-6442

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1245809458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11441 OSAGE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11441 OSAGE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333677",
            "telephone_number": "763-862-6442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE MINNESOTA ORAL AND MAXILLOFACIAL SURGEONS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "EL DEEB",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-862-6442"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Pines Counseling Center, Inc.
• Northland Dental Partners, PLLC
• Northland Hearing Centers, Inc.
• Amanda Elizabeth Northrup, NP
• Northside Minnesota Oral and Maxillofacial Surgeons
• Northstar Sleep Center LLC
• Northtown Psychology Associates LLC
• Northwest Passage High School
• Northwind Lung Specialists, P.a.
• Kelsey Nosek, DO

• Oral and Maxillofacial Surgery Clinic/Center in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.