Her and Man Town Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

HER AND MAN TOWN DENTAL PLLC

Doing business as

Boulder Trail Dental

Practice address

4135 Richard Ave Ste 103
Hermantown, MN 55811-2979

Phone

(218) 722-2428

Fax

(218) 722-0142

NPI assigned

Jul 29, 2024

Last updated

Jul 29, 2024By 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

Tracey Makitalo

Title

Insurance Coordinator

Phone

(218) 722-2428

Specialties & licenses 1

Addresses

Other names 1

• Boulder Trail Dental Doing business as

Locations

Practitioners 1

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.

• Meaghan Elizabeth Morrell, D.D.S

  • Dentist
  • Hermantown, MN
  • NPI 1356661516
  NPD

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1275362329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 RICHARD AVE STE 103",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558112979",
            "telephone_number": "218-722-2428",
            "fax_number": "218-722-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 RICHARD AVE STE 103",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558112979",
            "telephone_number": "218-722-2428",
            "fax_number": "218-722-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HER AND MAN TOWN DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "MAKITALO",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "218-722-2428"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Trail Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karissa Ann Haugen, PMHNP-BC
• Amy Colleen Hayes, MA, NCC, LPCC
• Casey Headlee, OT
• Emily Joanne Helgeson, PT,DPT,CLT
• Anne Katherine Hendricks
• Lauren Herbert
• Makyia Mercedes Herman
• Hermantown Valley Elder Care
• Laura Hoeschen, DPT
• Leiah Hoffman

• Dental Clinic/Center in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.