Nathalie Cristina Astudillo, DDS
Individual provider Active NPI Dentist · Mounds View, MN
NPI 1700306149 · NPPES record last updated Jun 27, 2017
Key facts
- NPI
- 1700306149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D13866 (MN)
- Practice address
- 2442 County Hwy 10
Mounds View, MN 55112 - Phone
- (763) 316-5400
- NPI assigned
- Jun 27, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170721001482 | MN | Order and Referring Only - Dentist |
4789954835 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D13866 | MN | Yes |
Addresses
Primary practice location
2442 County Hwy 10
Mounds View, MN 55112
Mailing address
2636 Fremont Ave S Apt 204
Minneapolis, MN 55408-1120
Other providers in Mounds View, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.