Organization Active NPI

Forever Smiles Partners PLLC

  • General Practice Dentistry
  • Chanhassen, MN
National Provider Identifier
1770190951
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FOREVER SMILES PARTNERS PLLC
Practice address
600 Market St Ste 130
Chanhassen, MN 55317-4570
Phone
(952) 937-5200
NPI assigned
Sep 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Authorized official

Name
Christopher Ibberson
Title
DDS/Owner
Phone
(507) 227-5549

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

600 Market St Ste 130
Chanhassen, MN 55317-4570

Mailing address

600 Market St Ste 130
Chanhassen, MN 55317-4570
Phone (952) 937-5200

Other identifiers 3

IdentifierTypeStateIssuer
1720165905MedicaidMN
1225140593OtherMNCMS
1447691431MedicaidMN

Other names 1

  • Bluff Creek Dental Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@bluffcreekdental.com

National Provider Directory

National Provider Directory

Locations

600 Market St
Ste 130
Chanhassen, MN 55317
Phone (952) 937-5200

Practitioners & affiliated clinicians

Practitioners 1

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": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1770190951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 MARKET ST STE 130",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553174570",
            "telephone_number": "952-937-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MARKET ST STE 130",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553174570",
            "telephone_number": "952-937-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER SMILES PARTNERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2023-10-18",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "IBBERSON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "DDS/OWNER",
        "authorized_official_telephone_number": "507-227-5549"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720165905",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS",
            "identifier": "1225140593",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447691431",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@bluffcreekdental.com",
            "affiliation": "N",
            "address_1": "600 Market St Ste 130",
            "city": "Chanhassen",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553174570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bluff Creek Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 18, 2023; 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.