Provider Demographics
NPI:1497814032
Name:MOMENTA, PC
Entity Type:Organization
Organization Name:MOMENTA, PC
Other - Org Name:STEPHEN GADIENT-KARL ANDREASEN & ASSOCIATES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDREASEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-482-0065
Mailing Address - Street 1:700 VILLAGE CENTER DR STE 170
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3025
Mailing Address - Country:US
Mailing Address - Phone:651-482-0065
Mailing Address - Fax:651-482-6144
Practice Address - Street 1:700 VILLAGE CENTER DR STE 170
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-3025
Practice Address - Country:US
Practice Address - Phone:651-482-0065
Practice Address - Fax:651-482-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN190000667Medicare PIN
MN19000386Medicare PIN
MN190000916Medicare PIN
MN190000666Medicare PIN
MN190000750Medicare PIN