National Provider Identifier Database

NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC
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.


Contact Information

NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC
5100 GAMBLE DR
SUITE 125
SAINT LOUIS PARK, MN55416-1585
Phone: 952-465-0105
Fax: 952-465-0106
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 261QS0112X

* Indicates primary specialty

NPI Profile & details for NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC

NPI Number 1699901140
Legal business name
LBN
NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC
Authorized official JULIE CHAVEZ - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 06/10/2009
Last updated 06/23/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • MN License #: D11399
  • MN Other: 3AI37NO BLUE CROSS BLUE SHIELD
  • MN Other: CO5268 MEDICARE PTAN
  • MN Other: DQ4459 MEDICARE RAILROAD PTAN
  • MN Other: 187847 U CARE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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