Individual provider Active NPI

Stephen R Gulbrandsen, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Edina, MN
National Provider Identifier
1609849850
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
D08618 Issued in MN
Practice address
7373 France Ave S
Suite 602
Edina, MN 55435-4534
Phone
(952) 835-5003
Fax
(952) 835-9598
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D08618 MN Primary

Addresses

Primary practice location

7373 France Ave S
Suite 602
Edina, MN 55435-4534

Mailing address

7373 France Ave S
Suite 602
Edina, MN 55435-4534
Phone (952) 835-5003

Other identifiers 2

IdentifierTypeStateIssuer
86-14825OtherMNMEDICA NUMBER
5B963RAOtherMNBCBS NUMBER

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D08618MNMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Oral and Maxillofacial Surgical Consultants PA Oral and Maxillofacial Surgery Current Accepting new patients

Locations

7770 Dell Rd
Ste 100
Chanhassen, MN 55317
Phone (952) 435-4150

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.

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609849850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S",
            "address_2": "SUITE 602",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354534",
            "telephone_number": "952-835-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S",
            "address_2": "SUITE 602",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354534",
            "telephone_number": "952-835-5003",
            "fax_number": "952-835-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULBRANDSEN",
        "first_name": "STEPHEN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D08618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA NUMBER",
            "identifier": "86-14825",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "5B963RA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.