MR. DREW JAMES CHRISTIANSON (NPI# 1164836334) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164836334 |
| Entity Type | Individual |
| Full Name | MR. DREW JAMES CHRISTIANSON |
| Credential | MDT |
| Practice Address |
12936 63rd Ave N Maple Grove MN 55369-6001 |
| Practice Telephone | 7635593400 |
| Mailing Telephone | 7635593400 |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2017-02-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 125J00000X | Dental Therapist | DT45 | MN | Dental Providers |
| Y | 125K00000X | Advanced Practice Dental Therapist | DT45 | MN | Dental Providers |
| Street Address |
12936 63RD AVE N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-6001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306998265 | Nasir Kamran Latif | Dentist | 12936 63rd Ave N, Maple Grove, MN 55369 | 2007-01-18 |
| 1336508670 | Johnathan Wermers | Dental Therapist | 12936 63rd Ave N, Maple Grove, MN 55369-6001 | 2016-02-15 |
| 1013395136 | Megan Becker | Dental Therapist | 12936 63rd Ave N, Maple Grove, MN 55369-6001 | 2015-05-08 |
| 1932504651 | Bria Kaiser | Dental Therapist | 12936 63rd Ave N, Maple Grove, MN 55369-6001 | 2014-10-23 |
| 1760703151 | Al Shifa Dentistry Pa | Clinic/Center | 12936 63rd Ave N, Maple Grove, MN 55369-6001 | 2010-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 125K00000X |
| Grouping | Dental Providers |
| Classification | Advanced Practice Dental Therapist |
| An Advanced Practice Dental Therapist is: (1) A dental therapist who has completed additional training beyond basic dental therapy education and provides dental services in accordance with state advanced practice dental therapist laws or statutes; or (2) A dental hygienist with a graduate degree in advanced dental therapy prepared for independent and interdependent decision making and direct accountability for clinical judgment across the dental health care continuum. The individual has been authorized by the relevant state board or a tribal entity to provide services under the remote supervision of a dentist. The functions of the advanced practice dental therapist vary based on the needs of the dentist, the educational preparation of the advanced practice dental therapist and state dental practice acts and regulations. |
| Notes: Source: Summarized from Minnesota Statute 150A.106. [7/1/2012: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578117438 | Christina Marie Hubred | Advanced Practice Dental Therapist | Miskovich Dental Clinic, 1121 Se 4th Avenue, Grand Rapids, MN 55744 | 2019-07-30 |
| 1144733130 | Lydia J Diekmann | Advanced Practice Dental Therapist | 2711 Broadway Ave Ste A00, Slayton, MN 56172-1313 | 2017-11-13 |
| 1073872503 | Brieanne Kelsey Borntrager | Advanced Practice Dental Therapist | 13899 Hwy 13 S Frnt Rd, Savage, MN 55378-2135 | 2012-05-03 |
| 1023541695 | Carley Banks | Advanced Practice Dental Therapist | 1575 20th St Nw, Faribault, MN 55021 | 2017-04-10 |
| 1033642947 | Lauren Johnson | Advanced Practice Dental Therapist | 1575 20th St Nw, Suite 102, Faribault, MN 55021-2930 | 2017-04-07 |
| 1063953032 | Ashley Hueman | Advanced Practice Dental Therapist | 973 Skyline Dr Sw, Rochester, MN 55902-1220 | 2017-03-10 |
| 1124483656 | Tanu Dhoopar | Advanced Practice Dental Therapist | 3152 Minnehaha Ave, Minneapolis, MN 55406-1934 | 2015-12-29 |
| 1548631187 | Kaitlin Siewert | Advanced Practice Dental Therapist | 520 Main Street, Hawley, MN 56549 | 2015-10-08 |
| City | MAPLE GROVE |
| Zip Code | 55369 |
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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.