NPIMap

Organization Active NPI

Northpark Dental

  • Dentist
  • Blaine, MN
National Provider Identifier
1710161500
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
NORTHPARK DENTAL
Practice address
9120 Baltimore St NE
Blaine, MN 55449-4337
Phone
(763) 786-1560
Fax
(763) 786-4390
NPI assigned
Dec 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Authorized official

Name
Paul Wayne Chadbourn, DDSNPI 1912044637
Title
President
Phone
(763) 786-1560

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
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

9120 Baltimore St NE
Blaine, MN 55449-4337

Mailing address

9120 Baltimore St NE
Blaine, MN 55449-4337
Phone (763) 786-1560

National Provider Directory

National Provider Directory

Locations

9120 Baltimore St NE
Blaine, MN 55449
Phone (763) 786-1560

Practitioners & affiliated clinicians

Practitioners 9

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": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1710161500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9120 BALTIMORE ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494337",
            "telephone_number": "763-786-1560",
            "fax_number": "763-786-4390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9120 BALTIMORE ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494337",
            "telephone_number": "763-786-1560",
            "fax_number": "763-786-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHPARK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "CHADBOURN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-786-1560",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; 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.