NPIMap

Organization Active NPI

Minnesota Orthodontics and Dentofacial Orthopedics PA

  • Specialist
  • Northfield, MN
National Provider Identifier
1417175696
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
10890 Issued in MN
Legal business name
MINNESOTA ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS PA
Practice address
2019 Jefferson Rd
Suite C
Northfield, MN 55057-3258
Phone
(507) 333-2990
Fax
(507) 645-1684
NPI assigned
Apr 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Authorized official

Name
Rebecca Craig
Title
Financial Coord
Phone
(651) 750-7273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 10890 MN Primary

Addresses

Primary practice location

2019 Jefferson Rd
Suite C
Northfield, MN 55057-3258

Mailing address

2019 Jefferson Rd
Suite C
Northfield, MN 55057-3258
Phone (507) 333-2990

Other names 1

  • Northfield Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Orthodontics6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

2019 Jefferson Rd
Ste C
Northfield, MN 55057
Phone (507) 333-2990

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": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1417175696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 JEFFERSON RD",
            "address_2": "SUITE C",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550573258",
            "telephone_number": "507-333-2990",
            "fax_number": "507-645-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 JEFFERSON RD",
            "address_2": "SUITE C",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550573258",
            "telephone_number": "507-333-2990",
            "fax_number": "507-645-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "FINANCIAL COORD",
        "authorized_official_telephone_number": "651-750-7273"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MN",
            "license": "10890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northfield Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northfield Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Northfield, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; 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.