Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1336138882 Individual Practitioner Female Practitioner

Dr. Tara Vonne Brodersen , DDS

Dentist - General Practice • Saint Paul, MN

Professional Overview & Biography Verified Profile Summary

Dr. Tara Brodersen, DDS is a registered healthcare professional specializing in Dentist - General Practice in Saint Paul, MN. Practice services are available at 200 UNIVERSITY AVE E under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

200 University Ave E

Saint Paul, MN 551012507

Telephone 6512912848
Fax 6516026885
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Saint Paul, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 14.0 Yrs
State Avg: 33.3 Yrs
Regional Practice Density
122 Specialists

Practicing in Saint Paul, MN (2262 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MN D11913

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Medicare Upin
H400538336 (MN)

Secondary Practice Locations

5320 Hyland Greens Dr Ste 200

Bloomington, MN 554373935

Phone: 9528316126

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Tracy Olmscheid , CRNA

Nurse Anesthetist, Certified Registered

NPI 1104578152

Certified Registered Nurse Anesthetist

NPI 1104787027

Master of Social Work, LGSW

Sarah Hoyt , CPNP

Nurse Practitioner - Pediatrics

NPI 1114434834

Certified Pediatric Nurse Practitioner

Amy Schwanke , APNP

Nurse Practitioner

NPI 1114701406

Advanced Practice Nurse Prescriber

Dr. Elizabeth Chalom , MD

Pediatrics - Pediatric Rheumatology

NPI 1154341147

Doctor of Medicine (M.D.)

Dr. Matthew Severson , MD

Physical Medicine & Rehabilitation

NPI 1164956413

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location March 08, 2019

Registered at 200 UNIVERSITY AVE E, SAINT PAUL, MN 551012507 (Tel: 6512912848)

📍
Updated Business Mailing Address March 08, 2019

Registered at 200 UNIVERSITY AVE E, SAINT PAUL, MN 551012507 (Tel: 6512912848)

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 5320 HYLAND GREENS DR STE 200, BLOOMINGTON, MN 554373935 (Tel: 9528316126)

📍
Updated Business Mailing Address July 08, 2007

Registered at 3935 36TH AVE S, MINNEAPOLIS, MN 554063208 (Tel: 6127280813)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as TARA BRODERSEN, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #D11913 in MN)

🟢
Initial NPI Registration & Enumeration October 18, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1336138882
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 18, 2005
Last Update: March 08, 2019
Sole Proprietor: Yes

Mailing Address

200 University Ave E

Saint Paul, MN 551012507

Phone: 6512912848

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.