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General NPI Number Information
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NPI Number | 1407000490
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Entity Type | Individual
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Provider Name | JODI LYNN AMDAHL ADT/RDH
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Gender | Female
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 590 W PARK ROAD
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City | REDWOOD FALLS
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State | MN
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Zip | 56283
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Country | US
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Telephone | 507-637-3581
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Fax | 507-627-8894
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Provider Business Mailing Address
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Address Line | 210 4TH STREET, PO BOX 272
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City | BALATON
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State | MN
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Zip | 56115
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Country | US
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Telephone | 507-276-1115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H7202
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 125K00000X
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Taxonomy Name | Advanced Practice Dental Therapist
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License Number | DT5
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License Number State | MN
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