North St. Paul Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8217 Issued in MN

Legal business name

NORTH ST. PAUL DENTAL

Practice address

2082 11TH Ave E
North St Paul, MN 55109-5112

Phone

(651) 770-6260

NPI assigned

Dec 17, 2008

Last updated

Dec 17, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

MAHTOMEDI DENTAL CLINICAs reported in NPPES

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

Authorized official

Name

Dr. Timothy A Bray, DDS

Title

Owner/ Dentist

Phone

(651) 770-6260

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

North St Paul Dental3 organizations share this tax ID, including this one

Part of

North St Paul Dental

Other organizations with this tax ID 2

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

• Mahtomedi Dental Clinic

  • General Practice Dentistry
  • Mahtomedi, MN
  • NPI 1326284597
  NPD tax ID
• Mahtomedi Dental Clinic

  • General Practice Dentistry
  • Mahtomedi, MN
  • NPI 1841462652
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Mahtomedi Dental Clinic

  • General Practice Dentistry
  • Mahtomedi, MN
  • NPI 1841462652
  NPPES parent name

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229472000000",
    "number": "1497991798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 MAHTOMEDI AVE",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151730",
            "telephone_number": "651-426-0011",
            "fax_number": "651-426-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2082 11TH AVE E",
            "city": "NORTH ST PAUL",
            "state": "MN",
            "postal_code": "551095112",
            "telephone_number": "651-770-6260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH ST. PAUL DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAHTOMEDI DENTAL CLINIC",
        "enumeration_date": "2008-12-17",
        "last_updated": "2008-12-17",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/ DENTIST",
        "authorized_official_telephone_number": "651-770-6260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "8217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "982017500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aimee Muellenbach, OTR/L
• Austin Murdock, DC
• Lori Beth Neubauer, LPCC
• Rachel Nordin, OTD, OTR/L
• North Metro Flex Academy
• Allison Elizabeth O'Halloran, PMHNP
• Carrie Marie O'Rourke
• Jamie Laurich Omann, RN, CPNP
• Amber Marie Peifer, MA, MPS, LPCC
• Mackenzie Marie Pelke, CCC-SLP

• General Practice Dentistry in North St Paul, MN
• Providers in North St Paul, 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 Dec 17, 2008; 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.