NPIMap

Organization Active NPI

Champlin Family Dental PA

  • General Practice Dentistry
  • Champlin, MN
National Provider Identifier
1992818751
Registry record updated Apr 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9624 Issued in MN
Legal business name
CHAMPLIN FAMILY DENTAL PA
Practice address
12233 Champlin Drive
Champlin, MN 55316
Phone
(763) 323-0678
Fax
(763) 323-9102
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2015

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

Authorized official

Name
Dr. Krista Susan Bauer, DDS
Title
Dentist
Phone
(763) 323-0678

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 9624 MN Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 11195 MN

Addresses

Primary practice location

12233 Champlin Drive
Champlin, MN 55316

Mailing address

12233 Champlin Drive
Champlin, MN 55316
Phone (763) 323-0678

Other identifiers 1

IdentifierTypeStateIssuer
624020800OtherMNMEDICAL ASSISTANCE TAX

National Provider Directory

National Provider Directory

Locations

12233 Champlin Dr
Champlin, MN 55316
Phone (763) 323-0678

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1992818751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12233 CHAMPLIN DRIVE",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "55316",
            "telephone_number": "763-323-0678",
            "fax_number": "763-323-9102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12233 CHAMPLIN DRIVE",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "55316",
            "telephone_number": "763-323-0678",
            "fax_number": "763-323-9102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPLIN FAMILY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "763-323-0678",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9624",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11195",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE TAX",
            "identifier": "624020800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; 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.