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General NPI Number Information
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NPI Number | 1306185160
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Entity Type | Organization
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Legal Business Name | ARROWHEAD ORTHODONTICS PC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 3617 W ARROWHEAD RD SUITE 200
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City | DULUTH
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State | MN
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Zip | 55811-4046
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Country | US
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Telephone | 218-722-4484
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Fax | 218-722-5217
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Provider Business Mailing Address
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Address Line | 3617 W ARROWHEAD RD SUITE 200
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City | DULUTH
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State | MN
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Zip | 55811-4046
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Country | US
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Telephone | 218-722-4484
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Fax | 218-722-5217
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Authorized Official
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Title or Position | OFFICE MGR
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Name | DEBBIE KOOP
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Credential |
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Telephone | 218-722-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12487
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12454
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11345
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License Number State | MN
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