Healthcare Provider Details

I. General information

NPI: 1659445765
Provider Name (Legal Business Name): NORTHERN ENDODONTIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST SUITE 530
DULUTH MN
55802-1701
US

IV. Provider business mailing address

324 W SUPERIOR ST SUITE 530
DULUTH MN
55802-1701
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-7557
  • Fax: 218-727-1182
Mailing address:
  • Phone: 218-727-7557
  • Fax: 218-727-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD10776
License Number StateMN

VIII. Authorized Official

Name: JOHN FREDERICK LINDQUIST
Title or Position: OFFICE MANAGER
Credential:
Phone: 218-727-7557