NPIMap

Organization Active NPI

Community Dental Care Inc

  • General Practice Dentistry
  • Crystal, MN
National Provider Identifier
1588005169
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COMMUNITY DENTAL CARE INC
Practice address
5700 Bottineau Blvd Ste 250
Crystal, MN 55429-3183
Phone
(763) 270-5776
NPI assigned
Jul 11, 2013
Last updated
Jun 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY DENTAL CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Korine C Schultz
Title
HR Director
Phone
(651) 925-8427

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

5700 Bottineau Blvd Ste 250
Crystal, MN 55429-3183

Mailing address

1670 Beam Ave
Maplewood, MN 55109-1201
Phone (651) 925-8400

National Provider Directory

National Provider Directory
Tax ID family
Community Dental Clinic4 organizations share this tax ID, including this one
Part of
Community Dental Clinic

Other organizations with this tax ID 3

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

Locations

5700 Bottineau Blvd
Ste 250
Crystal, MN 55429
Phone (763) 270-5776

3359 W Broadway Ave
Robbinsdale, MN 55422
Phone (763) 270-5776

Practitioners & affiliated clinicians

Practitioners 2

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": "1373500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1588005169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091201",
            "telephone_number": "651-925-8400",
            "fax_number": "651-925-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 BOTTINEAU BLVD STE 250",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554293183",
            "telephone_number": "763-270-5776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY DENTAL CARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY DENTAL CARE",
        "enumeration_date": "2013-07-11",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "KORINE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "651-925-8427"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; 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.