Healthcare Provider Details

I. General information

NPI: 1326191917
Provider Name (Legal Business Name): ROLF E LINDQUIST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E 3RD ST
GRAND MARAIS MN
55604-0670
US

IV. Provider business mailing address

PO BOX 670
GRAND MARAIS MN
55604-0670
US

V. Phone/Fax

Practice location:
  • Phone: 218-387-2774
  • Fax:
Mailing address:
  • Phone: 218-387-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8749
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: