Michelle Renee Bottin, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11376 Issued in MN

Practice address

1625 Lena Court
Suite a
Eagan, MN 55122-2959

Phone

(651) 452-4111

Fax

(651) 452-8824

NPI assigned

Nov 8, 2006

Last updated

May 21, 2014By the provider in NPPES

Sex

Female

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

Enrolled in MN

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.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Modern Dental Professionals, MN PC

  dba Midwest Dental

  • General Practice Dentistry
  • Eagan, MN
  • NPI 1710357520
  NPD (past)
• Wecare Dental of Eagan P.C

  dba Enhance Dental

  • Dental Clinic/Center
  • Eagan, MN
  • NPI 1316351703
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400630400000",
    "number": "1972673911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 LENA CT",
            "address_2": "SUITE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222959",
            "telephone_number": "651-452-4111",
            "fax_number": "651-452-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 LENA COURT",
            "address_2": "SUITE A",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222959",
            "telephone_number": "651-452-4111",
            "fax_number": "651-452-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTIN",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2014-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie G. Resnick, Psy.D., LLC
• Katerina Borja, FNP
• Todd Borstad, LICSW
• Michael Lee Bortel, M.A.
• Sarah Bos, PA
• Andrea Boulka, CPHT
• Maria Bradley, LICSW
• Brandon Mannie D.C. LLC (DBA Cliff Road Chiropractic)
• Jenna Brandt, DPT
• Daniel Martin Brasket, DC

• General Practice Dentistry in Eagan, MN
• Providers in Eagan, 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 May 21, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.