ADVANCED DERMATOLOGY CARE
NPI 1073614558
Dermatology in White Bear Lake, MN

Active since September 26, 2006CLIA 24D0897250 · Certificate of Compliance
4480 CENTERVILLE RD, WHITE BEAR LAKE, MN 55127(651) 484-2724(651) 484-2723 Get Directions Write a Review

NPPES record last updated: November 16, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Advanced Dermatology Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ADVANCED DERMATOLOGY CARE (NPI 1073614558) is a healthcare organization registered as a dermatology in White Bear Lake, Minnesota and active in the NPI registry since September 2006. The organization holds a CLIA Certificate of Compliance certificate valid through May 13, 2027 and lists Olaf J Rustad, Owner, as its authorized official.

NPPES Registry Identity

NPI1073614558
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameADVANCED DERMATOLOGY CARE MEDICAL COSMETIC AND SURGERY PA
Location Address4480 CENTERVILLE RDWhite Bear Lake, MN 55127-3674
Mailing Address4480 Centerville RdWhite Bear Lake, MN 55127-3674 · (651) 484-2724 · Fax (651) 484-2723
Fax(651) 484-2723
Organization SubpartYesParent: Advanced Dermatology Care Medical And Surgical Dermatology Pa
Authorized OfficialOlaf J RustadOwner · (651) 484-2724
Enumeration DateSeptember 26, 2006
Last NPPES UpdateNovember 16, 2018
NPI 1073614558 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

4480 CENTERVILLE RD, White Bear Lake, MN 55127

Other Names 1

Doing Business AsAdvanced Dermatology Care

Other Identifiers 1

OtherC01783MN · Ptan

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 24D0897250

Advanced Dermatology Care · White Bear Lake, MN
Active · expires May 13, 2027
CLIA Number24D0897250
Laboratory TypePhysician Office
Certificate Effective DateMay 14, 2025
Certificate Expiration DateMay 13, 2027
Laboratory DirectorOlaf J. Rustad
Laboratory Phone(651) 484-2724
Laboratory LocationAdvanced Dermatology Care4480 Centerville Rd, White Bear Lake, MN 55127
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127
Physician Assistant
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127
Physician Assistant
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127
Physician Assistant
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127
Physician Assistant
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127
Physician Assistant
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127
Dermatology
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127
Physician Assistant (Medical)
4480 CENTERVILLE RD
WHITE BEAR LAKE, MN 55127

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Advanced Dermatology Care Medical Cosmetic And Surgery PA's NPI number?

The NPI number for Advanced Dermatology Care Medical Cosmetic And Surgery PA is 1073614558. It was assigned to this organization in the NPPES registry on September 26, 2006. The provider is doing business as Advanced Dermatology Care.

Where is Advanced Dermatology Care Medical Cosmetic And Surgery PA located?

Advanced Dermatology Care Medical Cosmetic And Surgery PA is located at 4480 Centerville Rd, White Bear Lake, MN 55127. The listed phone number is (651) 484-2724.

What is Advanced Dermatology Care Medical Cosmetic And Surgery PA's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Advanced Dermatology Care Medical Cosmetic And Surgery PA hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 24D0897250) is associated with this NPI, valid through May 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Advanced Dermatology Care Medical Cosmetic And Surgery PA accept?

Health plans from HealthPartners and Medica list Advanced Dermatology Care Medical Cosmetic And Surgery PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Advanced Dermatology Care Medical Cosmetic And Surgery PA was last updated on November 16, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.