White Bear Lake Orthodontics

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

WHITE BEAR LAKE ORTHODONTICS

Practice address

4437 Lake Ave S
White Bear Lake, MN 55110-3455

Phone

(763) 999-0055

NPI assigned

Nov 17, 2020

Organization subpart

No

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

Authorized official

Name

Tamara Smith, DDS, MSDNPI 1376821157

Title

Owner/Orthodontist

Phone

(763) 999-0055

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Blaine Orthodontics2 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.

• Blaine Orthodontics

  • Dental Clinic/Center
  • Blaine, MN
  • NPI 1659031854
  NPD tax ID

Locations

Practitioners 1

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

• Tamara Smith, D.D.S., M.S.D

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Andover, MN
  • NPI 1376821157
  NPD Authorized official

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1730782467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4437 LAKE AVE S",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103455",
            "telephone_number": "763-999-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4437 LAKE AVE S",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103455",
            "telephone_number": "763-999-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE BEAR LAKE ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER/ORTHODONTIST",
        "authorized_official_telephone_number": "763-999-0055",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376821157",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• White Bear Dentists, PC
• White Bear Foot and Ankle Clinic Inc
• White Bear Foot and Ankle Clinic, Inc.
• White Bear Foot Clinic Inc
• White Bear Health Mart Pharmacy LLC
• White Bear Smiles, P.a.
• Meghan Wicklund, PHARMD
• Wildwood Chiropractic Center PA
• Horatius David Williams
• Julie Belle Williams, MSW LICSW LP LMFT LI

• Orthodontics and Dentofacial Orthopedics Dentistry in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.