Stillwater Modern Dentistry. PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

STILLWATER MODERN DENTISTRY. PC

Doing business as

Stillwater Modern Dentistry

Practice address

13331 60TH St N
Oak Park Heights, MN 55082-1287

Phone

(651) 352-4629

Fax

(651) 359-2935

NPI assigned

Feb 6, 2023

Organization subpart

No

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

Authorized official

Name

Krista Jean Koehler

Title

Owner

Phone

(651) 352-4629

Specialties & licenses 1

Addresses

Other names 1

• Stillwater Modern Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Natalie R Smith, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Atlanta, GA
  • NPI 1689125213
  NPD (past)

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

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1629774138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13331 60TH ST N",
            "city": "OAK PARK HEIGHTS",
            "state": "MN",
            "postal_code": "550821287",
            "telephone_number": "651-352-4629",
            "fax_number": "651-359-2935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER MODERN DENTISTRY. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-06",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "KOEHLER",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-352-4629"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stillwater Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Ann Stanek, MS, PAC
• Daniel B Stark, DPT
• Danielle M Stark, OTR/L
• Stillwater Family Dental
• Stillwater Medical Group
• Wilfred Oakley Stout, PAC
• Taylors Falls Chiropractic Office LTD
• McKenzie Nicole Tirrel Ostendorf, PT
• Kevin Tran, DDS
• Valley Senior Services Alliance

• General Practice Dentistry in Oak Park Heights, MN
• Providers in Oak Park Heights, 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 Feb 6, 2023; 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.