NPIMap

Organization Active NPI

The Dental Specialist of Minnesota, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Stillwater, MN
National Provider Identifier
1265097653
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
THE DENTAL SPECIALIST OF MINNESOTA, PLLC
Practice address
13961 60TH St N
Stillwater, MN 55082-1053
Phone
(651) 760-3681
Fax
(651) 760-3683
NPI assigned
May 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Authorized official

Name
Shannon Hesse
Title
Credentialing Specialist
Phone
(651) 746-2815

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

13961 60TH St N
Stillwater, MN 55082-1053

Mailing address

2200 County Road C W Ste 2210
Roseville, MN 55113-2551

Other names 1

  • The Dental Specialist St Croix Valley Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Specialists of Minnesota PLLC30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1265097653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COUNTY ROAD C W STE 2210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13961 60TH ST N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550821053",
            "telephone_number": "651-760-3681",
            "fax_number": "651-760-3683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL SPECIALIST OF MINNESOTA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-01",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "651-746-2815"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dental Specialist St Croix Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.