Borealis Dental Studio, P.a.

Primary specialty

DentistTaxonomy code 122300000X

License

D13152 Issued in MN

Legal business name

BOREALIS DENTAL STUDIO, P.A.

Practice address

12745 N 1St Ave
Lindstrom, MN 55045-9585

Phone

(651) 257-2720

NPI assigned

Jul 6, 2016

Last updated

Jul 6, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Becky Goolsby

Title

Business Manager

Phone

(405) 837-3159

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kai Anthony Ahlman, DDS

  • General Practice Dentistry
  • Lindstrom, MN
  • NPI 1245793678
  NPD (past)
• Sean Patrick Goolsby, DDS

  • General Practice Dentistry
  • Lindstrom, MN
  • NPI 1558654012
  NPD (past)

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1922450634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6892 256TH ST",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928362",
            "telephone_number": "405-837-3159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12745 N 1ST AVE",
            "city": "LINDSTROM",
            "state": "MN",
            "postal_code": "550459585",
            "telephone_number": "651-257-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOREALIS DENTAL STUDIO, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "GOOLSBY",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "405-837-3159"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kai Anthony Ahlman, DDS
• Bamboo Counseling Services PLLC
• Diana Allen Bjorkman, LADC
• Kindra L Bratteig, D.D.S.
• William Clare Cebulla, RN
• Chisago Lakes Dental Services LLC
• Chisago Lakes School District
• Bradley Clark, MA LPCC LADC

• Dentist in Lindstrom, MN
• Providers in Lindstrom, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; 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.