Paul Wayne Chadbourn, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8429 Issued in MN

Practice address

9120 Baltimore St NE
Blaine, MN 55449-4337

Phone

(763) 786-1560

Fax

(763) 786-4390

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 18, 2015 through Aug 18, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Northpark Dental

  • Dentist
  • Blaine, MN
  • NPI 1710161500
  NPD (past) Authorized official

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912044637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BLUE JAY LN",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551272015",
            "telephone_number": "651-490-1225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9120 BALTIMORE ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494337",
            "telephone_number": "763-786-1560",
            "fax_number": "763-786-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHADBOURN",
        "first_name": "PAUL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "8429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Jo Carmichael
• Lisa Cassman
• Rebecca J Cebuhar, PHARMD
• Center for Mental Health and Wellness, LLC
• Andrew Thomas Chadbourn, DMD
• Sherman CHI-Man Chan, DC
• Yi Catherine Chang, MD
• Daniel P Chaves, DC
• Dumah Chebo, RN
• Yingying Chen

• General Practice Dentistry in Blaine, MN
• Providers in Blaine, 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 Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.