SOUTHEASTERN MINNESOTA ORAL & MAXILLOFACIAL SURGERY ASSOCIATES (NPI# 1144413782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144413782 |
| Entity Type | Organization |
| Organization Name | SOUTHEASTERN MINNESOTA ORAL & MAXILLOFACIAL SURGERY ASSOCIATES |
| Practice Address |
304 Belle Ave Mankato MN 56001-5250 |
| Practice Telephone | 5073448698 |
| Practice Fax Number | 5073448759 |
| Mailing Telephone | 5073448698 |
| Mailing Fax Number | 5073448759 |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2007-08-27 |
| Authorized Official Name | DR. ROBERT A NUSTAD (VP, TREASURER) |
| Authorized Official Telephone | 5073448698 |
| Authorized Official Credential | DDS, MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770776312 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 3632 10th Ln Nw, Rochester, MN 55901-7032 | 2007-08-27 |
| 1902099559 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 2835 S Service Dr, Red Wing, MN 55066-1882 | 2007-08-27 |
| 1104019744 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 605 W Oakland Ave, Austin, MN 55912-2317 | 2007-08-27 |
| 1659492312 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 605 Hillcrest Ave Ste 130, Owatonna, MN 55060-3680 | 2007-04-02 |
| Street Address |
304 BELLE AVE |
| City | MANKATO |
| State | MN |
| Zip Code | 56001-5250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225014970 | Joseph Frank Foss | Pathology | 304 Belle Ave, Mankato, MN 56001-5250 | 2005-12-15 |
| 1881903524 | Denise M Abrahamson | Licensed Practical Nurse | 304 Belle Ave, Mankato, MN 56001-5250 | 2010-09-29 |
| 1356466718 | Shari Lynn Ward | Licensed Practical Nurse | 304 Belle Ave, Mankato, MN 56001-5250 | 2007-03-21 |
| 1255456604 | Kathi Jo Travaille | Dental Assistant | 304 Belle Ave, Mankato, MN 56001-5250 | 2007-03-21 |
| 1316062771 | Alyce Lorayne Konz | Licensed Practical Nurse | 304 Belle Ave, Mankato, MN 56001-5250 | 2007-03-21 |
| 1003931460 | Vicky Lynn Schubbe | Licensed Practical Nurse | 304 Belle Ave, Mankato, MN 56001-5250 | 2007-03-21 |
| 1730165499 | Dennis D Gremel | Pathology | 304 Belle Ave, Mankato, MN 56001-5250 | 2005-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154935435 | Kelly Nicole Ricke | Physical Medicine & Rehabilitation | 1 Civic Center Plaza, Hockey Office Complex, Mankato, MN 56001 | 2020-09-03 |
| 1649816786 | Ashley Lynn Walters | Technician, Other | 501 Madison Ave., Mankato, MN 56001 | 2019-11-25 |
| 1720631716 | Dovetail Traslation LLC | Interpreter | 212 Dublin Ct, Same As Above, Mankato, MN 56001 | 2019-07-19 |
| 1093377871 | Lindsey Keithahn | Counselor | 2100 Bassett Drive, Mankato, MN 56001 | 2019-07-02 |
| 1255803813 | Amy Marie Williams | Acupuncturist | 709 S. Front Street, Suite 5, Mankato, MN 56001 | 2018-12-20 |
| 1518437573 | Ashley Blanchard | Acupuncturist | Vida Salon Suites 1351 Madison Avenue, Suite F/ Suite 206, Mankato, MN 56001 | 2018-12-03 |
| 1831687235 | Christian Goetz | Specialist/Technologist | 401-477 South Rd, Mankato, MN 56001 | 2018-05-01 |
| 1366949141 | Minnesota State College and Universities | Specialist/Technologist | 135 Myers Field House, Mankato, MN 56001 | 2018-04-09 |
| 1780191775 | Kevin David Nelson | Pharmacist | 111 Redtail Ct Apt 308, Mankato, MN 56001 | 2017-12-29 |
| 1972014231 | Rylee Wagner | Speech-Language Pathologist | Mankato Clinic Pediatric Therapy Services, 150 St. Andrews Court, Suite 310, Mankato, MN 56001 | 2017-10-13 |
| Find all providers in zip 56001 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164763629 | Regents of The University of Minnesota | Clinic/Center | 515 Delaware St Se, 7th Floor Moos Tower, Minneapolis, MN 55455-0357 | 2013-03-08 |
| 1699901140 | Northern Star Oral and Maxillofacial Surgery Pllc | Clinic/Center | 5100 Gamble Dr, Suite 125, St Louis Park, MN 55416-1585 | 2009-06-10 |
| 1447429402 | Regents of The University of Minnesota | Clinic/Center | 515 Delaware St Se, 7th Floor Moos Tower, Minneapolis, MN 55455-0357 | 2008-02-25 |
| 1427237551 | Midtling Oral & Maxillofacial Surgery, Pa | Clinic/Center | 155 Wabasha St S, Suite 111, Saint Paul, MN 55107-1801 | 2007-10-25 |
| 1770776312 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 3632 10th Ln Nw, Rochester, MN 55901-7032 | 2007-08-27 |
| 1902099559 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 2835 S Service Dr, Red Wing, MN 55066-1882 | 2007-08-27 |
| 1104019744 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 605 W Oakland Ave, Austin, MN 55912-2317 | 2007-08-27 |
| 1821299041 | Twin Cities Oral & Maxillofacial Surgery Pa | Clinic/Center | 14635 Pennock Ave, #250, Apple Valley, MN 55124-6430 | 2007-05-29 |
| 1356542575 | Twin Cities Oral & Maxillofacial Surgery, Pa | Clinic/Center | 1655 Beam Ave, Ste 208, Maplewood, MN 55109-1163 | 2007-05-29 |
| 1154522373 | Twin Cities Oral & Maxillofaical Surgery Pa | Clinic/Center | 1790 Lexington Ave N, Roseville, MN 55113-6167 | 2007-05-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.