Healthcare Provider Details

I. General information

NPI: 1316097116
Provider Name (Legal Business Name): HULTGREN & HOXIE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 TERREY PINE CT SUITE 101
EDEN PRAIRIE MN
55347-1126
US

IV. Provider business mailing address

7825 TERREY PINE CT SUITE 101
EDEN PRAIRIE MN
55347-1126
US

V. Phone/Fax

Practice location:
  • Phone: 952-937-0111
  • Fax: 952-937-1492
Mailing address:
  • Phone: 952-937-0111
  • Fax: 952-937-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DIANE M ALICK
Title or Position: DDS, MS
Credential:
Phone: 952-937-0111