Individual provider Active NPI

Olivia Catherine Crane

  • General Practice Dentistry
  • Blaine, MN
National Provider Identifier
1679076376
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D14040 Issued in MN
Practice address
1384 109TH Ave NE Ste 200
Blaine, MN 55434-4543
Phone
(763) 757-6000
NPI assigned
Mar 9, 2018
Last updated
May 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X D14040 MN Primary

Addresses

Primary practice location

1384 109TH Ave NE Ste 200
Blaine, MN 55434-4543

Mailing address

7302 177TH Ave NE
Columbus, MN 55025-8875
Phone (641) 420-3764

Other practice location 1

3450 Lacey Rd
Downers Grove, IL 60515-5430
Phone (630) 743-4500

Other practice location 2

1970 Buerkle Rd
Saint Paul, MN 55110
Phone (651) 337-5695

Other practice location 3

1970 Buerkle Rd
Saint Paul, MN 55110
Phone (651) 337-5695

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
I20190719000846 MN Order and Referring Only - DentistPractitioner - Dentist 0547596165

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D14040MNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
White Bear Dentists, PC General Practice Past Accepting new patients
Blaine Dentistry, PC General Practice PastSince Jun 4, 2023 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": "1520553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1679076376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7302 177TH AVE NE",
            "city": "COLUMBUS",
            "state": "MN",
            "postal_code": "550258875",
            "telephone_number": "641-420-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1384 109TH AVE NE STE 200",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344543",
            "telephone_number": "763-757-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3450 Lacey Rd",
            "address_purpose": "LOCATION",
            "city": "Downers Grove",
            "state": "IL",
            "postal_code": "605155430",
            "country_code": "US",
            "telephone_number": "630-743-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1970 Buerkle Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "55110",
            "country_code": "US",
            "telephone_number": "651-337-5695",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1970 Buerkle Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "55110",
            "country_code": "US",
            "telephone_number": "651-337-5695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRANE",
        "first_name": "OLIVIA",
        "middle_name": "CATHERINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-09",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.