Paul Boettner D.D.S. PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12160 Issued in MN

Legal business name

PAUL BOETTNER D.D.S. PLLC

Doing business as

Bay Creek Dental

Practice address

1495 County Road 101 N
Suite 2
Plymouth, MN 55447-3078

Phone

(763) 476-6774

NPI assigned

Aug 10, 2007

Last updated

Jun 15, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Paul D Boettner, DDSNPI 1831380716

Title

Owner

Phone

(763) 476-6774

Specialties & licenses 1

Addresses

Other names 1

• Bay Creek Dental 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, and the practitioner matching its NPPES authorized official.

• Paul D Boettner, D.D.S.

  • General Practice Dentistry
  • Plymouth, MN
  • NPI 1831380716
  NPD (past) Authorized official

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339718400000",
    "number": "1679765929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1495 COUNTY ROAD 101 N",
            "address_2": "SUITE 2",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "55447",
            "telephone_number": "763-476-6774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 COUNTY ROAD 101 N",
            "address_2": "SUITE 2",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554473078",
            "telephone_number": "763-476-6774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL BOETTNER D.D.S. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2012-06-15",
        "status": "A",
        "authorized_official_last_name": "BOETTNER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-476-6774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Creek Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Holly Ann Parr, MA/CCC-SLP
• Kathy Pascale
• Pathways Psychological Services, P.a.
• Alaina Marie Pattinson, PAC
• Leah Vivian Patullo, DO
• Paul Boettner DDS PLLC
• Brennan Thomas Paulsen, DC
• Casey Lee Paulsen, DC
• Jessica Pawlik, BSCPT
• Alidra Payton

• General Practice Dentistry in Plymouth, MN
• Providers in Plymouth, 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 Jun 15, 2012; 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.