Luke Joseph Macmenamin, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D11556 Issued in MN

Practice address

8401 Seasons Pkwy
Woodbury, MN 55125-3414

Phone

(651) 738-2341

Fax

(651) 738-9048

NPI assigned

Nov 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 28, 2008 through Nov 28, 2026

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• The Oral Surgery Center

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Woodbury, MN
  • NPI 1104864529

  Oral and Maxillofacial Surgery

  NPD (past)
• Periodontal Center

  • Periodontics
  • Hudson, WI
  • NPI 1497348239
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679645733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 SEASONS PKWY",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253414",
            "telephone_number": "651-738-2341",
            "fax_number": "651-738-9048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 SEASONS PKWY",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253414",
            "telephone_number": "651-738-2341",
            "fax_number": "651-738-9048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACMENAMIN",
        "first_name": "LUKE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D11556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33797100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evan Ly
• Annalise Lynch, RDH, DT
• Bryan Joseph Lynn, MD
• Amy Marie Lyttle, MS, PA-C
• Linda M Maccornack, CRNA
• Alissa Leigh Madden, LICSW
• Denyse Madden
• Noah Aron Maddy, MD
• Gabriella Rose Madigan
• Catherine Madison, OTR/L

• Oral and Maxillofacial Surgery (Dentist) in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.