Breynne Stacey Fordahl, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12259 Issued in MN

Practice address

14727 60TH St. N
Stillwater, MN 55082

Phone

(651) 439-9060

Fax

(651) 379-9893

NPI assigned

Aug 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Breynne Stacey Fordahl Ratnayake Other name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Group Health, Inc.

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  Medicare reassignment NPD
• Group Health, Inc.

  • Pain Clinic/Center
  • Anoka, MN
  • NPI 1689068462
  NPD
• Group Health, Inc.

  • General Practice Dentistry
  • Saint Paul, MN
  • NPI 1952042053
  NPD

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1790795235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14727 60TH ST. N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "55082",
            "telephone_number": "651-439-9060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14727 60TH ST. N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "55082",
            "telephone_number": "651-439-9060",
            "fax_number": "651-379-9893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORDAHL",
        "first_name": "BREYNNE",
        "middle_name": "STACEY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "12259",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREYNNE",
            "last_name": "RATNAYAKE",
            "middle_name": "STACEY FORDAHL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Philip V. Flodin
• Hedit Florido-Bergad, DNP
• Fluid Health and Fitness
• Fong Medical Clinic, PA
• Jo Ann Ford, MSE LP
• Daniel Forest, D.C., C.L.S.
• Lindith M Fortin-Case, MSSW
• Teal J Foster, NP-C
• Foundation Therapies, Inc.
• Amy Catherine Fox, M.D.

• General Practice Dentistry in Stillwater, MN
• Providers in Stillwater, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.