NPIMap

Organization Active NPI

Dakota Valley Oral and Maxillofacial Surgery, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Paul, MN
National Provider Identifier
1366568206
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
DAKOTA VALLEY ORAL AND MAXILLOFACIAL SURGERY, PLLC
Practice address
2130 Cliff Rd
Suite 100
Saint Paul, MN 55122-2485
Phone
(651) 452-6933
NPI assigned
Mar 22, 2007
Last updated
Jul 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Authorized official

Name
Michelle Hartmann
Title
Clinic Manager
Phone
(651) 905-4834

Specialties & licenses 1

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

Addresses

Primary practice location

2130 Cliff Rd
Suite 100
Saint Paul, MN 55122-2485

Mailing address

2130 Cliff Rd
Suite 100
Saint Paul, MN 55122-2485
Phone (651) 452-6933

Other identifiers 1

IdentifierTypeStateIssuer
6B354SEOtherMNBCBS MN CLINIC NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040917000112 MN Part B Supplier - Clinic/Group Practice 9436127560 Receives reassigned benefits from 6 practitioners
Practice locations: Shakopee, MN; Owatonna, MN; Eagan, MN; Lakeville, MN; Burnsville, MN

National Provider Directory

National Provider Directory

Locations

14101 Fairview Dr
Ste 440
Burnsville, MN 55337
Phone (651) 452-6933

10440 185th St W
Ste 200
Lakeville, MN 55044
Phone (651) 452-6933

155 28th St NE
Owatonna, MN 55060
Phone (651) 452-6933

634 W Bridge St
Owatonna, MN 55060
Phone (507) 267-4929

2130 Cliff Rd
Ste 100
Saint Paul, MN 55122
Phone (651) 452-6933

8170 Old Carriage Ct
Ste 120
Shakopee, MN 55379
Phone (651) 905-4834

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1366568206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 CLIFF RD",
            "address_2": "SUITE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551222485",
            "telephone_number": "651-452-6933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 CLIFF RD",
            "address_2": "SUITE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551222485",
            "telephone_number": "651-452-6933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAKOTA VALLEY ORAL AND MAXILLOFACIAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "HARTMANN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "651-905-4834"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN CLINIC NUMBER",
            "identifier": "6B354SE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.