Borealis Dental Wyoming PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BOREALIS DENTAL WYOMING PA

Practice address

26357 Forest Blvd # 2
Wyoming, MN 55092-8353

Phone

(651) 462-7017

NPI assigned

Feb 21, 2024

Organization subpart

No

Name

Sean Goolsby, DDSNPI 1558654012

Title

President

Phone

(651) 757-0482

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

• Sean Patrick Goolsby, DDS

  • General Practice Dentistry
  • Lindstrom, MN
  • NPI 1558654012

  General Practice

  NPD Authorized official

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 5, 2024.

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1750147492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 886",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550920886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26357 FOREST BLVD # 2",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928353",
            "telephone_number": "651-462-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOREALIS DENTAL WYOMING PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-21",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "GOOLSBY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-757-0482",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Backman
• Anita Bajpai, MD
• Kaitlin Barabash, D.O.
• Kaylana Bell, OTR/L
• Lee Ann Bera, M.D.
• Gretchen Bosacker, M.D.
• Faith Bouttell
• Nissa K Brekke
• Kevin Anthony Brueske
• Jessica Lee Tomlin Brunfelt, NP

• All providers in Wyoming, MN
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; 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.