Dentist Providers In Blaine, Minnesota

Search Dentist NPI records in Blaine, MN

Search or browse through the NPI records of dentist registered healthcare providers with a business address in Blaine, MN. The listings include accepted insurance information, Medicare acceptance status, and PECOS enrollment data. The total number of NPI records is 95, of which 35 are registered as organizations and 60 as individuals. 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.

63% Individuals

37% Organizations

24% Female

39% Male

63% Individual Providers (60)37% Medical Organizations (35)24% Female Providers (23)39% Male Providers (37)

Map of Providers

We have mapped the Dentist providers in Blaine, MN to visually represent the practice location of each individual or organization. Click on any of the the pins to see the provider details at that location.

List of Providers

Table of Dentist NPI Profiles in Blaine, MN
NPI	Name	Address	Insurance	Medicare	PECOS
1013355593	JEFFREY MARK RUHLMANN (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental	Non-Participating Provider	YES
1033736368	LANDON THOMAS CASE (Individual)	10729 TOWN SQUARE DRIVE NE STE 100 BLAINE, MN 55449 (763) 225-1865	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1043379514	STEPHEN MICHAEL SAWYER (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana UnitedHealthcare	Non-Participating Provider	YES
1053791319	LING FAMILY DENTISTRY (Organization)	10945 ULYSSES ST NE BLAINE, MN 55434 (763) 784-1993		Non-Participating Provider	NO
1063725109	MELSTROM DENTAL PLLC TWIN OAKS DENTAL (Organization)	11949 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-8253		Non-Participating Provider	NO
1063768687	BLAINE DENTAL LLC DBA PRO DENTAL (Organization)	10210 BALTIMORE ST NE SUITE 100 BLAINE, MN 55449 (763) 231-2050	UnitedHealthcare	Non-Participating Provider	NO
1083777411	ANISSA JANE KOZLOWSKI (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1093468852	UNIVERSITY AVE DENTAL, PLLC (Organization)	10155 UNIVERSITY AVE NE STE 112 BLAINE, MN 55434 (763) 784-1242		Non-Participating Provider	NO
1093842841	PEIXIN LIU DDS FAMILY DENTAL CARE (Organization)	2407 109TH AVENUE SUITE 240 BLAINE, MN 55449 (763) 783-8200		Non-Participating Provider	NO
1093884280	KAREN DIZON COMPETENTE (Individual)	4255 PHEASANT RIDGE DR NE SUITE 407 BLAINE, MN 55449 (763) 225-6100	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1104249259	CAMPODONICO FAMILY & COSMETIC DENTISTRY PC ARDEN DENTAL ASSOCIATES (Organization)	11806 ABERDEEN ST NE SUITE 150 BLAINE, MN 55449 (763) 786-1545	UnitedHealthcare	Non-Participating Provider	NO
1104273085	THIEN QUANG PHAM (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (651) 621-4515	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	NO
1124125372	MATTHEW R NELSON (Individual)	10961 CLUB PARKWAY NE SUITE 240 BLAINE, MN 55449 (763) 780-1292		Non-Participating Provider	YES
1134266869	JOHN HAROLD TROSELIUS (Individual)	9120 BALTIMORE ST NE BLAINE, MN 55449 (763) 786-1560		Opted out of Medicare	YES
1134742430	MADELINE BEINLICH (Individual)	11949 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-8253	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1144393745	MICHAEL JOSEPH HAUWILLER (Individual)	11800 ABERDEEN ST NE SUITE 110 BLAINE, MN 55449 (763) 786-4280	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana	Non-Participating Provider	NO
1144978560	NORTHLAND DENTAL PARTNERS, PLLC (Organization)	4255 PHEASANT RIDGE DR NE STE 407 BLAINE, MN 55449 (763) 225-6100		Non-Participating Provider	NO
1154546877	CARLOS ERNESTO CAMPODONICO (Individual)	11806 ABERDEEN ST NE STE 150 BLAINE, MN 55449 (763) 786-1545	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	YES
1184030686	ANDREW THOMAS CHADBOURN (Individual)	9120 BALTIMORE ST NE BLAINE, MN 55449 (763) 786-1560	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana	Opted out of Medicare	YES
1184355349	JACOB DANIEL MEYER (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1184959454	ARIF NAZIR (Individual)	10210 BALTIMORE ST NE SUITE 100 BLAINE, MN 55449 (763) 231-2050	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	NO
1194949511	DON BLAKESLEE DDS PA BLAKESLEE DENTAL (Organization)	10155 UNIVERSITY AVE NE STE 112 BLAINE, MN 55434 (763) 784-1242		Non-Participating Provider	NO
1215003371	PDG,P.A. PARK DENTAL (Organization)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330		Non-Participating Provider	NO
1215090659	ROBB DAVID KOZLOWSKI (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1225233232	ANITA M THOMAS (Individual)	11949 CENTRAL AVENUE NE BLAINE, MN 55434 (763) 757-8253		Non-Participating Provider	NO
1225442627	NERMIN GIRGIS RIZK (Individual)	12265 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-1323	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Paramount Paramount Dental Renaissance Dental	Non-Participating Provider	NO
1235142829	RICHARD HENRY BARR (Individual)	631 125TH AVE NE BLAINE, MN 55434 (763) 757-2722	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	YES
1235587023	NIKLAS FUQIANG HEINE (Individual)	1384 109TH AVE NE SUITE 200 BLAINE, MN 55434 (763) 757-6000	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Paramount Paramount Dental	Non-Participating Provider	YES
1245973817	DENTAL MANAGEMENT PARTNERS LLC PRO DENTAL (Organization)	10210 BALTIMORE ST NE STE 100 BLAINE, MN 55449 (763) 231-2050		Non-Participating Provider	NO
1255044723	KYLE NOVOTNY DDS PLLC (Organization)	12265 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-1323		Non-Participating Provider	NO
1255442091	GREGORY R LIEBSCH (Individual)	10961 CLUB PARKWAY NE SUITE 240 BLAINE, MN 55449 (763) 780-1292		Non-Participating Provider	YES
1285377820	NORTHLAND DENTAL PARTNERS, PLLC (Organization)	261 COUNTY ROAD 10 NE STE 10 BLAINE, MN 55434 (763) 786-9644		Non-Participating Provider	NO
1285726430	MICHAEL JOHN NEMETZ (Individual)	113 NORTHTOWN DR NE BLAINE, MN 55434 (763) 780-5007	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana	Non-Participating Provider	NO
1285774398	ASSOCIATED DENTAL ASSURE DENTAL (Organization)	4255 PHEASANT RIDGE DR NE SUITE 407 BLAINE, MN 55449 (763) 225-6100		Non-Participating Provider	NO
1336361534	NORTHTOWN CENTER DENTAL CENTER NORTHTOWN DENTAL (Organization)	113 NORTHTOWN DR NE BLAINE, MN 55434 (763) 780-5007		Non-Participating Provider	NO
1336683036	LEGACY DENTAL CARE LLC (Organization)	12265 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-1323		Non-Participating Provider	NO
1356411698	BAYLON & BAYLON PLLC DRS BAYLON AND ASSOCIATE (Organization)	11943 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-2914	UnitedHealthcare	Non-Participating Provider	NO
1376680009	GREGORY JOHN POVOLNY (Individual)	9120 BALTIMORE ST NE BLAINE, MN 55449 (763) 786-1560		Non-Participating Provider	NO
1376687103	KILLIAN & MILNAR DENTISTRY PLLC ARDEN DENTAL ASSOCIATES (Organization)	11806 ABERDEEN ST NE SUITE 150 BLAINE, MN 55449 (763) 786-1545		Non-Participating Provider	NO
1376980755	SHAWN MCCARTHY (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 201-6960	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana	Non-Participating Provider	NO
1396307161	MARCELLUS HORSCH (Individual)	4255 PHEASANT RIDGE DR NE STE 407 BLAINE, MN 55449 (763) 225-6100	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental Renaissance Dental	Non-Participating Provider	NO
1396398160	TAYLOR JOHNSON (Individual)	10155 UNIVERSITY AVE NE STE 112 BLAINE, MN 55434 (763) 784-1242		Non-Participating Provider	NO
1437767555	KYLE STEPHEN NOVOTNY (Individual)	12265 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-1323		Non-Participating Provider	NO
1447539242	AMY ELIZABETH DAHLGREN (Individual)	4255 PHEASANT RIDGE DR NE BLAINE, MN 55449 (763) 225-6100	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Renaissance Dental	Non-Participating Provider	YES
1447614318	CHRISTOPHER DAVID KLEKAMP (Individual)	1351 113TH AVE NE STE 400B BLAINE, MN 55434 (763) 415-1222	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Cigna Healthcare Delta Dental Florida Combined Life Guardian Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	YES
1467563510	ORAL & MAXILLOFACIAL SURGERY SPECIALISTS, PA OMS SPECIALISTS (Organization)	11800 ABERDEEN ST NE STE 130 BLAINE, MN 55449 (763) 757-2220		Non-Participating Provider	NO
1477600807	PETER JON THOMPSON (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1497433676	BRIAN PISARCIK (Individual)	1384 109TH AVE NE BLAINE, MN 55434 (763) 757-6000	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1497982318	SARAH ROSE LATTERELL (Individual)	10945 ULYSSES ST NE BLAINE, MN 55434 (763) 784-1993		Opted out of Medicare	YES
1538220207	ABERDEEN DENTAL ASSOCIATES (Organization)	11800 ABERDEEN ST NE SUITE 110 BLAINE, MN 55449 (763) 786-4280		Non-Participating Provider	NO
1538231527	MICHELLE BEBEAU (Individual)	1566 125TH AVE NE BLAINE, MN 55449 (763) 757-1535	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1548641657	OLUWAKAYODE ADEBOLA OLOWOYO GRACEPOINT FAMILY DENTISTRY (Organization)	4851 124TH LN NE BLAINE, MN 55449 (952) 457-1462	UnitedHealthcare	Non-Participating Provider	NO
1578089207	ANDREA BERGE (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1578570115	CRAIG LAWRENCE RATHJEN (Individual)	607 COUNTY ROAD 10 NE SUITE #100 BLAINE, MN 55434 (763) 780-1300	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	YES
1619601820	SIMIL TAMSEEL FATIMA (Individual)	10210 BALTIMORE ST NE STE 100 BLAINE, MN 55449 (763) 231-2050	Humana	Non-Participating Provider	NO
1619619129	NORTHLAND DENTAL PARTNERS, PLLC CENTRAL AVENUE DENTAL CARE (Organization)	12371 ULYSSES ST NE BLAINE, MN 55434 (763) 203-6100		Non-Participating Provider	NO
1629137500	CORINE NICOLE MCLELLAN (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1629199617	ST. CROIX ENDODONTICS, P.A. (Organization)	11945 CENTRAL AVE NE BLAINE, MN 55434 (763) 767-9119		Non-Participating Provider	NO
1659447670	DOUGLAS T JONAK DDS PA (Organization)	800 MAIN ST NE BLAINE, MN 55434 (763) 757-2768		Non-Participating Provider	NO
1659543320	PEIXIN LIU DDS FAMILY DENTAL CARE (Organization)	2407 109TH AVENUE SUITE 240 BLAINE, MN 55449 (763) 783-8200		Non-Participating Provider	NO
1679076376	OLIVIA CATHERINE CRANE (Individual)	1384 109TH AVE NE STE 200 BLAINE, MN 55434 (763) 757-6000	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1689779282	DANIEL LARSCHEID (Individual)	11806 ABERDEEN ST NE 150 BLAINE, MN 55449 (763) 786-1545	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1689994006	RACHEL ANNE MONDRY (Individual)	11800 ABERDEEN ST NE STE 110 BLAINE, MN 55449 (763) 786-4280	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana	Non-Participating Provider	YES
1699140236	UYEN PHAM (Individual)	11800 ABERDEEN ST NE STE 110 BLAINE, MN 55449 (763) 786-4280	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental Renaissance Dental	Non-Participating Provider	NO
1699829697	GROUP HEALTH PLAN INC HEALTHPARTNERS BLAINE DENTAL CLINIC (Organization)	10961 CLUB WEST PKWY BLAINE, MN 55449 (763) 780-1292		Non-Participating Provider	NO
1710161500	NORTHPARK DENTAL (Organization)	9120 BALTIMORE ST NE BLAINE, MN 55449 (763) 786-1560		Non-Participating Provider	NO
1730310145	JOSEPH WILLIAM WINEGAR (Individual)	4255 PHEASANT RIDGE DR NE BLAINE, MN 55449 (763) 225-6100		Non-Participating Provider	YES
1730788498	MODERN DENTAL PROFESSIONALS (Organization)	676 COUNTY ROAD 10 NE BLAINE, MN 55434 (763) 780-5007		Non-Participating Provider	NO
1730838186	FAMILY ORAL SURGERY SPECIALISTS, PLC (Organization)	261 COUNTY ROAD 10 NE STE 10 BLAINE, MN 55434 (763) 786-9644		Non-Participating Provider	NO
1760541908	DENNIS LEE PARVEY (Individual)	12265 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-1323		Non-Participating Provider	YES
1760551469	CHRISTINE D. BAYLON (Individual)	11943 CENTRAL AVE NE BLAINE, MN 55434 (763) 757-2914	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	YES
1790389005	ST. CROIX ENDODONTICS ST. CROIX ENDODONTICS (Organization)	11855 ULYSSES ST NE STE 260 BLAINE, MN 55434 (763) 767-9119		Non-Participating Provider	NO
1790522191	KASSIDY STEEN (Individual)	1384 109TH AVE NE STE 200 BLAINE, MN 55434 (763) 757-6000	BEST Life Florida Combined Life Humana	Non-Participating Provider	NO
1790883130	DON R BLAKESLEE (Individual)	10155 UNIVERSITY AVE NE STE #112 BLAINE, MN 55434 (763) 784-1242		Non-Participating Provider	YES
1801910377	ORTHODONTIC CARE GROUP ORTHODONTIC CARE SPECIALISTS (Organization)	11806 ABERDEEN ST NE BLAINE, MN 55449 (763) 757-2550		Non-Participating Provider	NO
1871653212	BRETT ARTHUR KNUTSON (Individual)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 755-1330	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1881894137	KRIS DAVID JOHNSON (Individual)	11800 ABERDEEN ST. NE SUITE 140 BLAINE, MN 55449 (763) 772-0330	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental	Non-Participating Provider	NO
1891865861	HAMID REZA ABEDI (Individual)	1384 109TH AVE NE STE 200 BLAINE, MN 55434 (949) 230-7692	Aetna CVS Health Ambetter from Arizona Complete Health Ambetter from Arkansas Health & Wellness Ambetter from Louisiana Healthcare Connections Ambetter from Superior HealthPlan Ambetter of Oklahoma Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental PPO DeltaCare USA EMI Health Florida Combined Life Guardian Humana Paramount Paramount Dental Renaissance Dental Solstice Healthplans of Texas Inc. TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	YES
1902398944	ORTHODONTIC SPECIALISTS OF MINNESOTA, P.L.L.C. THE DENTAL SPECIALISTS- ORTHODONTICS (Organization)	12904 CENTRAL AVE NE BLAINE, MN 55434 (763) 201-6960		Non-Participating Provider	NO
1912044637	PAUL WAYNE CHADBOURN (Individual)	9120 BALTIMORE ST NE BLAINE, MN 55449 (763) 786-1560	Anthem Blue Cross and Blue Shield Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana	Opted out of Medicare	YES
1912070590	SANDRA HUEBSCH KENNEDY (Individual)	11800 ABERDEEN ST NE STE 110 BLAINE, MN 55449 (763) 786-4280	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1922101443	BRUCE F HOLT (Individual)	10961 CLUB PARKWAY NE SUITE 240 BLAINE, MN 55449 (763) 780-1292		Non-Participating Provider	NO
1922308113	DENTAL SPECIALISTS OF MINNESOTA, PLLC THE DENTAL SPECIALISTS (Organization)	12904 CENTRAL AVE. NE BLAINE, MN 55434 (651) 746-0587		Non-Participating Provider	NO
1932200037	NORTHLAND ENDODONTICS PA (Organization)	11800 ABERDEEN ST NE SUITE 140 BLAINE, MN 55449 (763) 772-0330		Non-Participating Provider	NO
1932298460	DONNA JEAN MATTSCHECK (Individual)	11800 ABERDEEN ST NE #140 BLAINE, MN 55449 (763) 772-0330		Opted out of Medicare	YES
1942267422	KELLY ANNE TIKKANEN LANG (Individual)	261 HWY 10 NE BLAINE, MN 55434 (763) 786-9644	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1952088270	ZACHARY MADER (Individual)	10945 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 784-1993		Non-Participating Provider	NO
1952989717	REBECCA ANN FRENZ (Individual)	10961 CLUB WEST PKWY STE 240 BLAINE, MN 55449 (763) 780-1292		Non-Participating Provider	YES
1952997421	NODLANDMONDRY, P.L.L.C. (Organization)	11800 ABERDEEN ST NE STE 110 BLAINE, MN 55449 (402) 560-8346		Non-Participating Provider	NO
1962939546	NICOLETTE GENGEL (Individual)	1384 109TH AVE NE STE 200 BLAINE, MN 55434 (763) 757-6000	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	NO
1972171247	CAROL ELLENS (Individual)	10945 ULYSSES ST NE BLAINE, MN 55434 (763) 784-1993	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Humana Paramount Paramount Dental UnitedHealthcare	Non-Participating Provider	NO
1972614717	DOUGLAS GREEN (Individual)	10729 TOWN SQUARE DR NE #150 BLAINE, MN 55449 (763) 269-8650	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	YES
1982007803	BLAINE DENTISTRY, PC BLAINE DENTISTRY (Organization)	1384 109TH AVE NE SUITE 200 BLAINE, MN 55434 (763) 757-6000	Humana	Non-Participating Provider	NO
1982709754	CHAD WOJTOWICK (Individual)	261 NE COUNTY ROAD 10 BLAINE, MN 55434 (763) 786-9644	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1982930525	JOHN CHARLES HITZEMANN (Individual)	11354 WILDWOOD CT NE BLAINE, MN 55449 (763) 783-0474		Non-Participating Provider	NO

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