NPIMap

Organization Active NPI

Crystal Dental Care Inc

  • Dental Clinic/Center
  • Crystal, MN
National Provider Identifier
1316689201
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
CRYSTAL DENTAL CARE INC
Practice address
5640 W Broadway Ave
Crystal, MN 55428-3556
Phone
(176) 353-7365
NPI assigned
Apr 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Dr. Kimberlee Murphy, DDSNPI 1285706317
Title
Owner
Phone
(763) 537-3655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

5640 W Broadway Ave
Crystal, MN 55428-3556

Mailing address

5640 W Broadway Ave
Crystal, MN 55428-3556
Phone (176) 353-7365

Other identifiers 1

IdentifierTypeStateIssuer
1285706317MedicaidMN

Other names 1

  • CRYSTAL DENTAL CARE INC Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL crystaldental@popp.net Direct

National Provider Directory

National Provider Directory

Locations

5640 W Broadway Ave
Minneapolis, MN 55428
Phone (763) 537-3655

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1316689201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 W BROADWAY AVE",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554283556",
            "telephone_number": "176-353-7365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 W BROADWAY AVE",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554283556",
            "telephone_number": "176-353-7365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL DENTAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "KIMBERLEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-537-3655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285706317",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "crystaldental@popp.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5640 W Broadway Ave",
            "city": "Crystal",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554283556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CRYSTAL DENTAL CARE INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.