NPIMap

Organization Active NPI

Oral and Maxillofacial Surgical Consultants PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Chanhassen, MN
National Provider Identifier
1720206428
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ORAL AND MAXILLOFACIAL SURGICAL CONSULTANTS PA
Practice address
7770 Dell Road
Suite 100
Chanhassen, MN 55317-9316
Phone
(952) 435-4150
Fax
(952) 435-7548
NPI assigned
Apr 20, 2007
Last updated
Jun 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Authorized official

Name
Debi A Keckhafer
Title
Practice Manager
Phone
(952) 841-9658

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

7770 Dell Road
Suite 100
Chanhassen, MN 55317-9316

Mailing address

6350 143Rd Street
Suite 206
Savage, MN 55378-2890
Phone (952) 435-4150

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040630000218 MN Part B Supplier - Clinic/Group Practice 2961489844 Receives reassigned benefits from 16 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chanhassen, MN; Wayzata, MN; Savage, MN; Edina, MN

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Oral and Maxillofacial Surgical Consultants PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

14050 Nicollet Ave
Ste 305
Burnsville, MN 55337
Phone (952) 435-4150

16570 W 78th St
Ste 4
Eden Prairie, MN 55346
Phone (952) 975-0605

6350 W 143rd St
Ste 206
Savage, MN 55378
Phone (952) 435-4150

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1720206428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 143RD STREET",
            "address_2": "SUITE 206",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "553782890",
            "telephone_number": "952-435-4150",
            "fax_number": "952-435-7548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7770 DELL ROAD",
            "address_2": "SUITE 100",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553179316",
            "telephone_number": "952-435-4150",
            "fax_number": "952-435-7548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFACIAL SURGICAL CONSULTANTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "KECKHAFER",
        "authorized_official_first_name": "DEBI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "952-841-9658"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chanhassen, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; 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.