MINNESOTA MAXILLOFACIAL AND ORAL CONSULTANTS (NPI# 1417034661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417034661 |
| Entity Type | Organization |
| Organization Name | MINNESOTA MAXILLOFACIAL AND ORAL CONSULTANTS |
| Practice Address |
15600 36th Ave N Ste 100 Plymouth MN 55446-3369 |
| Practice Telephone | 7635597688 |
| Practice Fax Number | 7635592237 |
| Mailing Telephone | 7635597688 |
| Mailing Fax Number | 7635592237 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. ABDOLLAH RAHIMI (OWNER) |
| Authorized Official Telephone | 7635597688 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D10465 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE CROSS/BLUE SHIELD | 52D13MI | 01 |
| Street Address |
15600 36TH AVE N STE 100 |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55446-3369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114552379 | Molly M Mahoney | Pharmacist | 4110 Juneau Lane N, Plymouth, MN 55446 | 2020-03-09 |
| 1073064804 | Owen Payne Kusick | Student in an Organized Health Care Education/Training Program | 16717 49th Pl N, Plymouth, MN 55446 | 2016-10-17 |
| 1043696214 | Kari Shoemaker | Speech-Language Pathologist | 5855 Cheshire Parkway, Plymouth, MN 55446 | 2015-08-10 |
| 1902206899 | Kathleen E Steensma | Nurse Practitioner | 15700 37th Ave N. #110, Plymouth, MN 55446 | 2014-08-27 |
| 1851715163 | Group Health Plan Inc | Clinic/Center | 5000 Fernbrook Ln N, Plymouth, MN 55446 | 2014-02-06 |
| 1588903009 | Laura Davidson | Physician Assistant | 3365 Plymouth Blvd., Suite 110, Plymouth, MN 55446 | 2013-02-04 |
| 1366680688 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 6025 Shenandoah Ln N, Plymouth, MN 55446 | 2009-01-23 |
| 1205046646 | Merida A Miller | Obstetrics & Gynecology | 4155 Cty Rd 101 N, Plymouth, MN 55446 | 2007-05-23 |
| 1376684746 | West Metro Ophthalmology, Pa | Ophthalmology | 15655 37th Ave N Ste 200, Plymouth, MN 55446 | 2007-02-09 |
| 1952401390 | Grand St Paul Cvs LLC | Pharmacy | 4140 Rd 101 N, Plymouth, MN 55446 | 2006-09-25 |
| Find all providers in zip 55446 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| 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 |
|---|---|---|---|---|
| 1235204116 | Daniel Shane O'brien | Dentist | 74 Summer St, Plymouth, MA 02360-3457 | 2006-11-23 |
| 1245253111 | Plymouth Oral & Facial Surgery, Plc | Dentist | 9416 S Main St, Suite 211, Plymouth, MI 48170-4157 | 2006-07-25 |
| 1982662821 | Dennie L Malone | Dentist | 133 Seaview Dr, Plymouth, MA 02360-8510 | 2006-05-02 |
| 1619947314 | William Peter Hoffmann | Dentist | 15655 37th Ave. N., 280, Plymouth, MN 55446-4000 | 2006-01-25 |
| 1528326428 | William Mcneely Lane | Dentist | 30 Resnik Rd, Plymouth, MA 02360-7211 | 2012-04-27 |
| 1578872685 | Minnesota Oral & Maxillofacial Surgery, P.a. | Dentist | 15655 37th Ave. N., 280, Plymouth, MN 55446-4000 | 2010-10-07 |
| 1376610352 | David Allen Aldrich | Dentist | 9416 S Main St, Plymouth, MI 48170-4157 | 2006-11-29 |
| 1194826917 | Metropolitan Oral and Maxillofacial Surgeons Pa | Dentist | 2855 Campus Dr, Ste 670, Plymouth, MN 55441-2649 | 2006-09-26 |
| 1407954761 | Lane Oral & Maxillofacial Surgery PC | Dentist | 30 Resnik Rd, Plymouth, MA 02360 | 2006-09-20 |
| 1831295369 | Norman J Betts | Dentist | 9416 S Main St, Suite 211, Plymouth, MI 48170-4157 | 2006-09-15 |
| Find all providers in PLYMOUTH | ||||
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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.