BOREALIS DENTAL STUDIO, P.A. (NPI# 1922450634) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922450634 |
| Entity Type | Organization |
| Organization Name | BOREALIS DENTAL STUDIO, P.A. |
| Practice Address |
12745 N 1st Ave Lindstrom MN 55045-9585 |
| Mailing Address |
6892 256th St Wyoming MN 55092-8362 |
| Practice Telephone | 6512572720 |
| Mailing Telephone | 4058373159 |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |
| Authorized Official Name | BECKY GOOLSBY (BUSINESS MANAGER) |
| Authorized Official Telephone | 4058373159 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | D13152 | MN | Dental Providers |
| Street Address |
12745 N 1ST AVE |
| City | LINDSTROM |
| State | MN |
| Zip Code | 55045-9585 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558654012 | Sean Patrick Goolsby | Dentist | 12745 N 1st Ave, Lindstrom, MN 55045-9585 | 2011-05-17 |
| 1245793678 | Kai Anthony Ahlman | Dentist | 12745 N 1st Ave, Lindstrom, MN 55045-9585 | 2019-04-11 |
| 1306255070 | Chisago Lakes Dental Services LLC | Dentist | 12745 N 1st Ave, Lindstrom, MN 55045-9585 | 2014-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043818354 | Eddiction Medicine Pllc | Clinic/Center | 12018 285th Street, Lindstrom, MN 55045 | 2020-10-09 |
| 1780844613 | Deboorah A Gibson | Custodial Care Facility | 28131 Newberry Trail, Lindstrom, MN 55045 | 2008-06-13 |
| 1831356773 | Lake Optometric Vision Pa | Optometrist | 12700 Lake Blvd, Lindstrom, MN 55045 | 2008-05-19 |
| 1861534315 | Vernon Bruce Lovdokken | Optometrist | 12700 Lake Boulevard, Lindstrom, MN 55045 | 2007-02-13 |
| 1922167329 | Robert Donald Waddell Jr. | Chiropractor | 12099 Lake Blvd, Lindstrom, MN 55045 | 2006-12-08 |
| 1366516767 | Kimberley M Johnson Dc | Chiropractor | 12814 Lake Boulevard, Lindstrom, MN 55045 | 2006-11-17 |
| 1225112022 | Lindstrom Family Dentistry LLC | Dentist | 30554 Park Street North, Lindstrom, MN 55045 | 2006-10-25 |
| 1508959164 | Joseph Virga | Chiropractor | 12670 Lake Blvd, Lindstrom, MN 55045 | 2006-10-02 |
| 1609975713 | Four Winds Center for Wellness Inc | Social Worker | 28141 Lakelawn Drive, Lindstrom, MN 55045 | 2006-09-22 |
| 1629079983 | Michael A Hursh | Dentist | 30554 Park St, Lindstrom, MN 55045 | 2005-08-09 |
| Find all providers in zip 55045 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730788498 | Modern Dental Professionals | Dentist | 676 County Road 10 Ne, Blaine, MN 55434-2329 | 2020-10-22 |
| 1588261812 | New London Family Dental | Dentist | 15 Ash St Se, New London, MN 56273 | 2020-10-09 |
| 1164036422 | Lolita Hicks | Dentist | 1290 Salem Rd Sw Ste 10, Rochester, MN 55902-4210 | 2020-09-03 |
| 1326650961 | Mcgann Family Dental | Dentist | 8981 33rd St N, Lake Elmo, MN 55042-9209 | 2020-08-17 |
| 1154931988 | Jordan Jeffrey Bolger | Dentist | 13899 Highway 15 S Frontage Rd, Savage, MN 55378-5537 | 2020-08-06 |
| 1285243733 | Grant R. Sorensen, Dds | Dentist | 1029 3rd Ave Ste 1, Worthington, MN 56187-2399 | 2020-07-29 |
| 1851909436 | Matthew Rohlf | Dentist | 5378 E Viking Blvd, Wyoming, MN 55092 | 2020-07-20 |
| 1205444106 | Sidra Zahooruddin | Dentist | 107 Dupont Ave, Nw, Renville, MN 56284 | 2020-07-16 |
| 1104434380 | Jongseuk Lim | Dentist | 1119 W Frontage Rd, Owatonna, MN 55060-5663 | 2020-07-14 |
| 1699393942 | Danika Elizabeth Jackson | Dentist | 237 Radio Dr Ste 110, Woodbury, MN 55125-4478 | 2020-07-13 |
| 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.