Riley Scott Baumgartner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D15099 Issued in MN

Practice address

29663 Gateway Ave
Chisago City, MN 55013-0339

Phone

(651) 257-3639

NPI assigned

Jun 10, 2024

Last updated

Jun 10, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Modern Dental Professionals Minnesota PC

  dba Midwest Dental - Chisago City

  • General Practice Dentistry
  • Chisago City, MN
  • NPI 1043589484
  NPD (past)

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1689416810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5850 169TH AVE NW",
            "city": "RAMSEY",
            "state": "MN",
            "postal_code": "553035896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29663 GATEWAY AVE",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550130339",
            "telephone_number": "651-257-3639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUMGARTNER",
        "first_name": "RILEY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D15099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Christopherson Anderson, MD
• Revana Emad Awadallah, DMD
• Jessica Ria Babcock, PA-C
• Courtney Marie Bagley, M.A. LMFT
• Natasha Barnes, LMFT
• Danielle Kallin Brink, DC
• Susie Joy Brooks
• Chisago County Council for Exceptional Individuals, Inc. (Chisago Lakes Achievement Center)
• Chisago County Human Services
• Chisago Drug

• General Practice Dentistry in Chisago City, MN
• Providers in Chisago City, 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 10, 2024; 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.