TWIN CITIES ORAL & MAXILLOFAICAL SURGERY PA (NPI# 1154522373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154522373 |
| Entity Type | Organization |
| Organization Name | TWIN CITIES ORAL & MAXILLOFAICAL SURGERY PA |
| Practice Address |
1790 Lexington Ave N Roseville MN 55113-6167 |
| Mailing Address |
925 Highway 55 Ste 202 Hastings MN 55033-3734 |
| Practice Telephone | 6514889884 |
| Mailing Telephone | 6514373262 |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SHIRLEY HERDING (OFFICE MANAGER) |
| Authorized Official Telephone | 6514889884 |
| 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 |
| Street Address |
1790 LEXINGTON AVE N |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113-6167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427050483 | Richard A Wiberg | Dentist | 1790 Lexington Ave N, Ste B, Roseville, MN 55113-6167 | 2005-06-02 |
| 1356835748 | Emily Ellingson | Optometrist | 1790 Lexington Ave N, Roseville, MN 55113-6167 | 2018-06-19 |
| 1639431000 | Daniel Benjamin Myers | Optometrist | 1790 Lexington Ave N, Roseville, MN 55113-6167 | 2012-06-12 |
| 1699838011 | Lexington Dental | Dentist | 1790 Lexington Ave N, Suite B, Roseville, MN 55113-6167 | 2006-12-18 |
| 1619994480 | Maureen A. Ohland | Dentist | 1790 Lexington Ave N, Roseville, MN 55113-6167 | 2006-07-16 |
| 1023000312 | Robert Bach Kennedy | Optometrist | 1790 Lexington Ave N, Roseville, MN 55113-6167 | 2005-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| 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 |
| 1144413782 | Southeastern Minnesota Oral & Maxillofacial Surgery Associates | Clinic/Center | 304 Belle Ave, Mankato, MN 56001-5250 | 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 |
| 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.