Christopher Michael De la Mater, DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

D12752 Issued in MN

Practice address

3833 Coon Rapids Blvd NW Ste 220
Coon Rapids, MN 55433-2597

Phone

(763) 421-6271

Fax

(763) 421-6273

NPI assigned

Feb 14, 2007

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

Locations

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

• MN Dental Service Providers LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Coon Rapids, MN
  • NPI 1962242719
  NPD
• Associated Oral and Maxillofacial Surgeons, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Fridley, MN
  • NPI 1457495491
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1992848808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3867 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332518",
            "telephone_number": "763-586-0070",
            "fax_number": "763-586-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 COON RAPIDS BLVD NW STE 220",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332597",
            "telephone_number": "763-421-6271",
            "fax_number": "763-421-6273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7136 University Ave NE",
            "address_purpose": "LOCATION",
            "city": "Fridley",
            "state": "MN",
            "postal_code": "554323100",
            "country_code": "US",
            "telephone_number": "763-574-1636 x206",
            "fax_number": "763-586-0072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA MATER",
        "first_name": "CHRISTOPHER",
        "middle_name": "MICHAEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "D12752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin R Davis, MD
• Nauzjalee D Davis
• Sarah Elizabeth Davis, LMFT
• Taylor Lynn Dawson
• Daystar Homecare LLC
• Clarice R Decker, MD
• Renee Alarie Deegan, M.A., BCBA
• Donna Degracia, P.A.
• Ma Lourdes Yepes Dela Cruz
• Sarah Elizabeth Delaforest, LAC

• Oral & Maxillofacial Surgery (D.M.D.) in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.