NPIMap

Organization Active NPI

Orono Dental Care PC

  • General Practice Dentistry
  • Orono, MN
National Provider Identifier
1700058690
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9161 Issued in MN
Legal business name
ORONO DENTAL CARE PC
Practice address
2765 Kelley Parkway
Suite 140
Orono, MN 55356
Phone
(952) 449-9494
Fax
(952) 449-9499
NPI assigned
Mar 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Authorized official

Name
Brianna Brooke Hammer, DDSNPI 1497136014
Title
President
Phone
(952) 449-9494

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 9161 MN Primary

Addresses

Primary practice location

2765 Kelley Parkway
Suite 140
Orono, MN 55356

Mailing address

2765 Kelley Parkway
Suite 140
Orono, MN 55356
Phone (952) 449-9494

Other names 1

  • Crystal Lake Family Dental Care, PLLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211026002489 MN DME Supplier - Oral Surgery - Dentist 5698163590 Practice locations: Orono, MN

National Provider Directory

National Provider Directory

Locations

2765 Kelley Pkwy
Ste 140
Orono, MN 55356
Phone (763) 420-6834

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638489600000",
    "number": "1700058690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2765 KELLEY PARKWAY",
            "address_2": "SUITE 140",
            "city": "ORONO",
            "state": "MN",
            "postal_code": "55356",
            "telephone_number": "952-449-9494",
            "fax_number": "952-449-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2765 KELLEY PARKWAY",
            "address_2": "SUITE 140",
            "city": "ORONO",
            "state": "MN",
            "postal_code": "55356",
            "telephone_number": "952-449-9494",
            "fax_number": "952-449-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORONO DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2021-12-03",
        "certification_date": "2021-11-29",
        "status": "A",
        "authorized_official_last_name": "HAMMER",
        "authorized_official_first_name": "BRIANNA",
        "authorized_official_middle_name": "BROOKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-449-9494",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Lake Family Dental Care, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Orono, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; 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.