Mario Alberto Olguin Medina, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14777 Issued in MN

Practice address

3650 Braddock Ave NE Ste 200
Buffalo, MN 55313-3681

Phone

(763) 270-6900

NPI assigned

Jun 21, 2022

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• C&M Dental PLLC

  dba Crystal Dental Care

  • Dental Clinic/Center
  • Crystal, MN
  • NPI 1689461840
  NPD Authorized official
• Community Dental Care Inc

  • General Practice Dentistry
  • Buffalo, MN
  • NPI 1275280810
  NPD (past)

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1932830965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 UNIVERSITY AVE SE APT 26",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554141727",
            "telephone_number": "612-850-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 BRADDOCK AVE NE STE 200",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553133681",
            "telephone_number": "763-270-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLGUIN MEDINA",
        "first_name": "MARIO",
        "middle_name": "ALBERTO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-21",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sally Lynn O'Malley, CCC-SLP
• Nicholas O'Rourke, LGSW
• Ciara Nicole Oawster, DPT
• Carol Ann Obrien, MSW LICSW
• Brett G Oden, MD
• Olson Chiropractic Clinic, Inc
• Dale Arlen Olson
• Katie Olson, RD, LD
• Mark Dale Olson, DC
• Ryan Jay Olson, D.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.