Healthcare Provider Details

I. General information

NPI: 1609090711
Provider Name (Legal Business Name): NORWOOD DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E. WILSON STREET
NORWOOD MN
55368-0717
US

IV. Provider business mailing address

P.O. BOX 717
NORWOOD MN
55368-0717
US

V. Phone/Fax

Practice location:
  • Phone: 952-467-3518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10567
License Number StateMN

VIII. Authorized Official

Name: DANIEL J ROSS
Title or Position: CEO
Credential:
Phone: 952-467-3518