NPIMap

Organization Active NPI

Community Dental Care Inc

  • General Practice Dentistry
  • Buffalo, MN
National Provider Identifier
1275280810
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COMMUNITY DENTAL CARE INC
Practice address
3650 Braddock Ave NE
Buffalo, MN 55313-3666
Phone
(651) 925-8400
NPI assigned
Mar 3, 2022
Last updated
Mar 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

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

Authorized official

Name
Korine Carlson
Title
HR Director
Phone
(651) 925-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3650 Braddock Ave NE
Buffalo, MN 55313-3666

Mailing address

1670 Beam Ave Ste 204
Maplewood, MN 55109-1227
Phone (651) 925-8400

National Provider Directory

National Provider Directory
Tax ID family
Community Dental Care Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

3650 Braddock Ave NE
Buffalo, MN 55313
Phone (651) 925-8400

1670 Beam Ave
Ste 204
Saint Paul, MN 55109
Phone (651) 925-8400

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1275280810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 BEAM AVE STE 204",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091227",
            "telephone_number": "651-925-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 BRADDOCK AVE NE",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553133666",
            "telephone_number": "651-925-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY DENTAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-03",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "KORINE",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "651-925-8400"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; 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.