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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 Specialty Code Provider Type

Oral and Maxillofacial Surgery

261QS0112X
Indicates primary specialty

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

NPI Number 1699901140
LBN Legal business name NORTHERN STAR ORAL AND MAXILLOFACIAL SURGERY PLLC
Authorized official JULIE CHAVEZ - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/10/2009
Last updated 06/23/2014 - About 12 years ago
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 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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