Northern Star Oral and Maxillofacial Surgery PLLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

D11399 Issued in MN

Legal business name

NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC

Practice address

5100 Gamble Dr
Suite 125
St Louis Park, MN 55416-1585

Phone

(952) 465-0105

Fax

(952) 465-0106

NPI assigned

Jun 10, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Julie A Chavez, DDSNPI 1851364392

Title

Owner

Phone

(952) 465-0105

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 3

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.

• Julie A Chavez, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • St Louis Park, MN
  • NPI 1851364392
  Medicare reassignment Authorized official
• David L Basi, DMD PHD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Minneapolis, MN
  • NPI 1104898626
  NPD (past)
• Pamela J Hughes, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Portland, OR
  • NPI 1497727911
  NPD (past)

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1699901140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 GAMBLE DR",
            "address_2": "SUITE 125",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161585",
            "telephone_number": "952-465-0105",
            "fax_number": "952-465-0106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 GAMBLE DR",
            "address_2": "SUITE 125",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161585",
            "telephone_number": "952-465-0105",
            "fax_number": "952-465-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-10",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-465-0105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D11399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CO5268",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD PTAN",
            "identifier": "DQ4459",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "187847",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3AI37NO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Norgren, M.S., CCC-SLP
• Terry Lynn Norman, MA, LAMFT
• Grace Ann Norris
• Northern Integrated Health, Inc.
• Northern Skies Psychotherapy and Nutrition Counseling
• Northland Dental Partners, PLLC (Metro Dentalcare St. Louis Park West 36th Street)
• Northland Dental Partners, PLLC (Metro Dentalcare St. Louis Park)
• Monica Norwick
• Rebecca Nosan
• Makenna Nosbusch, MA, LPCC

• Oral and Maxillofacial Surgery Clinic/Center in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.