Osage Dental Associates PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9770 Issued in MN

Legal business name

OSAGE DENTAL ASSOCIATES PA

Practice address

11441 Osage St NW
Coon Rapids, MN 55433-3677

Phone

(763) 757-6600

Fax

(763) 757-3693

NPI assigned

Jan 22, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tammy Shadrick

Title

Om

Phone

(763) 757-6600

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265586192",
    "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",
            "telephone_number": "763-757-6600",
            "fax_number": "763-757-3693"
        },
        {
            "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": "763-757-6600",
            "fax_number": "763-757-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSAGE DENTAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHADRICK",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "OM",
        "authorized_official_telephone_number": "763-757-6600"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Orellana, LPCC
• Ruth Ann Ormiston, LICSW
• Kelly Jo Ortenblad, MSW, LICSW
• Orthodontic Care Group (Orthodontic Care Specialists)
• Orthodontics Specialist of Minnesota P.L.L.C. (The Dental Specialist-Orthodontics)
• Blessing Osibodu, NP
• Sarah Lynn Oswald, PA-C
• Kylie Ann Otte, LICSW
• Duane H Otten, NP
• Renae Machelle Otto, PA

• General Practice Dentistry in Coon Rapids, MN
• Providers in Coon Rapids, 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 22, 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.