ST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLC
NPI 1124776687
Dentist - Oral and Maxillofacial Surgery in Mendota Heights, MN

Q: What is St Paul Oral Surgery And Dental Implants LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since March 14, 2022CLIA 24D2172546 · Waiver

750 MAIN ST STE 200, MENDOTA HEIGHTS, MN 55118(651) 451-1873(651) 451-8010 Get Directions Write a Review

NPPES record last updated: March 14, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About St Paul Oral Surgery And Dental Implants Llc NPPES

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

ST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLC (NPI 1124776687), doing business as St. Paul Oral Surgery - Mendota Heights, is a healthcare organization registered as an oral and maxillofacial surgery in Mendota Heights, Minnesota and active in the NPI registry since March 2022. The organization holds a CLIA Waiver certificate valid through January 1, 2027 and lists Celia Hayes, Credentialing Coordinator, as its authorized official.

NPPES Registry Identity

NPI1124776687

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLC

Location Address750 MAIN ST STE 200Mendota Heights, MN 55118-3767

Mailing Address750 Main St Ste 200Mendota Heights, MN 55118-3767 · (651) 451-1873 · Fax (651) 451-8010

Phone(651) 451-1873

Fax(651) 451-8010

Organization SubpartYes

Authorized OfficialCelia HayesCredentialing Coordinator · (217) 540-2100

Enumeration DateMarch 14, 2022

NPPES CertifiedMarch 14, 2022

✔ NPI 1124776687 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

Definition

An oral and maxillofacial surgery dentist specialized in 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.

750 MAIN ST STE 200, Mendota Heights, MN 55118

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Other Names 1

Doing Business AsSt. Paul Oral Surgery - Mendota Heights

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 MULTIPLE SINGLE SPECIALTY GROUP

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 Waiver 24D2172546

St Paul Oral Surgery And Dental Implants · Mendota Heights, MN

Active · expires Jan 1, 2027

CLIA Number24D2172546

Laboratory TypeDental Clinic Speciality

Certificate Effective DateJanuary 2, 2025

Certificate Expiration DateJanuary 1, 2027

Laboratory DirectorMartina Hovey

Laboratory Phone(651) 286-8118

Laboratory LocationSt Paul Oral Surgery And Dental Implants750 Main St, Suite 203, Mendota Heights, MN 55118

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

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 St Paul Oral Surgery And Dental Implants LLC's NPI number?

The NPI number for St Paul Oral Surgery And Dental Implants LLC is 1124776687. It was assigned to this organization in the NPPES registry on March 14, 2022. The provider is doing business as St. Paul Oral Surgery - Mendota Heights.

Where is St Paul Oral Surgery And Dental Implants LLC located?

St Paul Oral Surgery And Dental Implants LLC is located at 750 Main St Ste 200, Mendota Heights, MN 55118. The listed phone number is (651) 451-1873.

What is St Paul Oral Surgery And Dental Implants LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Does St Paul Oral Surgery And Dental Implants LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2172546) is associated with this NPI, valid through January 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for St Paul Oral Surgery And Dental Implants LLC was last updated on March 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.