Dr Breynne Stacey Fordahl, DDS in Stillwater, MN

Dr Breynne Stacey Fordahl, DDS is a medicare enrolled "Dentist - General Practice" provider in Stillwater, Minnesota. Her current practice location is 14727 60th St. N, Stillwater, Minnesota. You can reach out to her office (for appointments etc.) via phone at (651) 439-9060.

Dr Breynne Stacey Fordahl is licensed to practice in Minnesota (license number D12259) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1790795235.

Contact Information

	Dr Breynne Stacey Fordahl, DDS
	14727 60th St. N, Stillwater, MN 55082
	(651) 439-9060
	(651) 379-9893

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Breynne Stacey Fordahl
Gender	Female
Speciality	Dentist - General Practice
Location	14727 60th St. N, Stillwater, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1790795235
Provider Enumeration Date: 08/08/2006
Last Update Date: 11/30/2012

Medicare PECOS Information:

PECOS PAC ID: 7315249976
Enrollment ID: I20220504000141

Medical Identifiers

Medical identifiers for Dr Breynne Stacey Fordahl such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1790795235	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
122300000X	Dentist	12259 (Minnesota)	Secondary
1223G0001X	Dentist - General Practice	D12259 (Minnesota)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Breynne Stacey Fordahl allows following entities to bill medicare on her behalf.

Entity Name	Group Health Plan Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1710924683 PECOS PAC ID: 1759293954 Enrollment ID: O20031105000417

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Breynne Stacey Fordahl is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Breynne Stacey Fordahl, DDS 14727 60th St. N, Stillwater, MN 55082 Ph: (651) 439-9060	Dr Breynne Stacey Fordahl, DDS 14727 60th St. N, Stillwater, MN 55082 Ph: (651) 439-9060

Reviews and Comments

Dentist in Stillwater, MN

Dr. Sarah Louise Bogel, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 1395 Curve Crest Blvd W, Stillwater, MN 55082 Phone: 651-430-0036
Timothy Huska, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 13961 60th St N, Stillwater, MN 55082 Phone: 651-439-2600
Richard L Schneider, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 126 Main St N, Stillwater, MN 55082 Phone: 651-439-3637 Fax: 651-439-4655
Steven D Johnson, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 1701 Curve Crest Blvd W, Suite 108, Stillwater, MN 55082 Phone: 651-439-8030 Fax: 651-351-0821
Dr. Polly Jo Courtney Logan, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 13961 60th St, St Croix Valley Dental, Stillwater, MN 55082 Phone: 651-439-2600 Fax: 651-439-2211
Martin A Tahara, DMD, MD Dentist Medicare: Medicare Enrolled Practice Location: 1701 Curve Crest Blvd W, Suite 108, Stillwater, MN 55082 Phone: 651-439-8030 Fax: 651-351-0821
Carson Cannon, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 2850 Curve Crest Blvd W Ste 200, Stillwater, MN 55082 Phone: 651-439-9400

Dr Breynne Stacey Fordahl, DDS - Medicare Dentist in Stillwater, MN