Abc Dental PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D11438 Issued in MN

Legal business name

ABC DENTAL PA

Practice address

3371 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2624

Phone

(763) 421-4640

Fax

(763) 421-0112

NPI assigned

Jan 4, 2007

Last updated

Aug 22, 2020By 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

Dr. Katherine M C Bolterman, D.D.S.NPI 1265584148

Title

Owner President

Phone

(763) 421-4640

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Katherine M.C. Bolterman, D.D.S.

  • General Practice Dentistry
  • Coon Rapids, MN
  • NPI 1265584148
  NPD (past) Authorized official

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972650745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3371 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332624",
            "telephone_number": "763-421-4640",
            "fax_number": "763-421-0112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3371 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332624",
            "telephone_number": "763-421-4640",
            "fax_number": "763-421-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOLTERMAN",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "M C",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "763-421-4640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D11438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 1Absolute Supplemental Nursing, LLC (1Absolute HomeCare)
• 1St Choice Home Care, Inc
• 3D Innovative Cares LLC
• Michelle Kett Abbott, CRNA
• Nuha Abdelrahim, RDN
• Sahaam Ahmed Abdi
• Bangean K Abdullah, MD
• Syed Kashan Ali Haider Abidi, M.D
• Mohamed Aboubadria

• Dental Clinic/Center in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.