Leann Caroll Bain, RDA – Dental Assistant

Key facts

NPI: 1407048853
Entity type: Individual (NPI type 1)
Primary specialty: Dental Assistant 126800000X
License: A3972 (MN)
Practice address: 1789 Woodlane Dr
Suite D
Woodbury, MN 55125-3910
Phone: (651) 738-1284
Fax: (651) 738-0072
NPI assigned: Aug 9, 2007
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Woodgrove Dental PA General Practice Dentistry · Woodbury, MN · NPI 1356539993

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
A3972	MN	MD	Dental Assistant

Practice roles

Organization	Specialty	Status	New patients
Woodgrove Dental PA		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dental Assistant	126800000X	A3972	MN	Yes

Addresses

Primary practice location

1789 Woodlane Dr
Suite D
Woodbury, MN 55125-3910

Mailing address

1789 Woodlane Dr
Suite D
Woodbury, MN 55125-3910
Phone (651) 738-1284

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 9, 2007.

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186617600000",
    "number": "1407048853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1789 WOODLANE DR",
            "address_2": "SUITE D",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253910",
            "telephone_number": "651-738-1284",
            "fax_number": "651-738-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1789 WOODLANE DR",
            "address_2": "SUITE D",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253910",
            "telephone_number": "651-738-1284",
            "fax_number": "651-738-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAIN",
        "first_name": "LEANN",
        "middle_name": "CAROLL",
        "name_prefix": "Mrs.",
        "credential": "RDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2007-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "MN",
            "license": "A3972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

All providers in Woodbury, MN · Dental Assistant in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.