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General NPI Number Information
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NPI Number | 1518086750
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH SERVICE OF NORTHERN MINNESOTA PA
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 802 W 42ND ST
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City | HIBBING
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State | MN
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Zip | 55746
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Country | US
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Telephone | 218-263-8381
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Fax | 218-263-8383
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Provider Business Mailing Address
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Address Line | 802 W 42ND ST
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City | HIBBING
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State | MN
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Zip | 55746
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Country | US
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Telephone | 218-263-8381
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Fax | 218-263-8383
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Authorized Official
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Title or Position | CEO
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Name | NATHAN PEDERSEN
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Credential | DDS
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Telephone | 218-263-8381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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