Jennifer Marie Bertrand, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12950 Issued in MN

Practice address

7270 Forestview LN N Ste 250
Maple Grove, MN 55369-5605

Phone

(763) 424-9202

Fax

(763) 424-9399

NPI assigned

May 26, 2011

Last updated

Jan 24, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jennifer Marie Dylla Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Prairie Dental Group

  • General Practice Dentistry
  • Eden Prairie, MN
  • NPI 1104057975
  NPD (past)

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

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548288000000",
    "number": "1417240243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7270 FORESTVIEW LN N STE 250",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695605",
            "telephone_number": "763-424-9202",
            "fax_number": "763-424-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7270 FORESTVIEW LN N STE 250",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695605",
            "telephone_number": "763-424-9202",
            "fax_number": "763-424-9399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6608 Flying Cloud Dr. Suite 200",
            "address_2": "Prairie Dental Group",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "55344",
            "country_code": "US",
            "telephone_number": "952-903-5000",
            "fax_number": "952-944-0642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERTRAND",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-26",
        "last_updated": "2019-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DYLLA",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ross Alexander Bergfalk, MT, CDP
• Alexandra M Bergman
• Yetmwork Berhanu, M,D
• Raeann Elizabeth Hope Berk
• Kelly Berscheit, LICSW
• Baylee Mae Beulke
• Gisela Bhoelai
• Teresa Biehn, PH.D.
• Mary Ellen Bigham, MSW, LICSW
• Robert John Biglow, MA, LPCC, LADC

• General Practice Dentistry in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; 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.