Individual provider Active NPI

Stephen Anthony Bejarano, DDS

  • General Practice Dentistry
  • Circle Pines, MN
National Provider Identifier
1609865062
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D10627 Issued in MN
Practice address
2 S Pine Dr
Circle Pines, MN 55014-1798
Phone
(763) 786-8460
Fax
(763) 786-1792
NPI assigned
Oct 18, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D10627 MN Primary

Addresses

Primary practice location

2 S Pine Dr
Circle Pines, MN 55014-1798

Mailing address

2 S Pine Dr
Circle Pines, MN 55014-1848
Phone (763) 786-8460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200803001200 MN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4789803339

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D10627MNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Circle Pines Family Dental PLLC PastSince Aug 3, 2025 Accepting new patients
Glen Oaks Dental PLLP General Practice Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1609865062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 S PINE DR",
            "city": "CIRCLE PINES",
            "state": "MN",
            "postal_code": "550141848",
            "telephone_number": "763-786-8460",
            "fax_number": "763-786-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 S PINE DR",
            "city": "CIRCLE PINES",
            "state": "MN",
            "postal_code": "550141798",
            "telephone_number": "763-786-8460",
            "fax_number": "763-786-1792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEJARANO",
        "first_name": "STEPHEN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Circle Pines, MN

Sources for this page

Verify at the official NPI Registry.