Active NPI
Andrew Crist
- General Practice Dentistry
- Maplewood, MN
National Provider Identifier
1902390917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1001806-15
- Practice address
- 1670 Beam Ave Ste 204
Maplewood, MN 55109 - Phone
- (651) 925-8400
- NPI assigned
- Jun 22, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1001806-15 | WI | Primary |
Addresses
Primary practice location
1670 Beam Ave Ste 204
Maplewood, MN 55109
Mailing address
13133 6TH St N
Stillwater, MN 55082-1926
Phone (651) 592-9284
Other practice location 1
745 Sommers St N
Hudson, WI 54016-2314
Phone (715) 381-9785
Other practice location 2
745 Sommers St N
Hudson, WI 54016-2314
Phone (715) 381-9785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001806-15 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Dental Care Inc | General Practice | Current | Accepting new patients |
Locations
1670 Beam Ave
Ste 204
Saint Paul, MN 55109
Phone (651) 925-8400
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571356800000",
"number": "1902390917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13133 6TH ST N",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550821926",
"telephone_number": "651-592-9284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 BEAM AVE STE 204",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "55109",
"telephone_number": "651-925-8400"
}
],
"practiceLocations": [
{
"address_1": "745 Sommers St N",
"address_purpose": "LOCATION",
"city": "Hudson",
"state": "WI",
"postal_code": "540162314",
"country_code": "US",
"telephone_number": "715-381-9785",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "745 Sommers St N",
"address_purpose": "LOCATION",
"city": "Hudson",
"state": "WI",
"postal_code": "540162314",
"country_code": "US",
"telephone_number": "715-381-9785",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CRIST",
"first_name": "ANDREW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-22",
"last_updated": "2019-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "1001806-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.