NPIMap

Organization Active NPI

Central Minnesota Orthodontica

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Saint Cloud, MN
National Provider Identifier
1720146111
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
11705 Issued in MN
Legal business name
CENTRAL MINNESOTA ORTHODONTICA
Practice address
1411 W Saint Germain St
Suite 104
Saint Cloud, MN 56301-4121
Phone
(320) 255-1111
Fax
(320) 255-1602
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Authorized official

Name
Shelly Am Nordin
Title
Business Manager
Phone
(320) 255-1111

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 8228 MN
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 11705 MN Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X D12904 MN

Addresses

Primary practice location

1411 W Saint Germain St
Suite 104
Saint Cloud, MN 56301-4121

Mailing address

1411 W Saint Germain St
Suite 104
Saint Cloud, MN 56301-4121
Phone (320) 255-1111

National Provider Directory

National Provider Directory
Tax ID family
Central Minnesota Orthodontica2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1411 W Saint Germain St
Ste 104
Saint Cloud, MN 56301
Phone (320) 255-1111

Practitioners & affiliated clinicians

Practitioners 2

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": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313712000000",
    "number": "1720146111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W SAINT GERMAIN ST",
            "address_2": "SUITE 104",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014121",
            "telephone_number": "320-255-1111",
            "fax_number": "320-255-1602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 W SAINT GERMAIN ST",
            "address_2": "SUITE 104",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014121",
            "telephone_number": "320-255-1111",
            "fax_number": "320-255-1602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA ORTHODONTICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2011-08-19",
        "status": "A",
        "authorized_official_last_name": "NORDIN",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "AM",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "320-255-1111"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "8228",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "11705",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "D12904",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; 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.