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General NPI Number Information
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NPI Number | 1578211991
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Entity Type | Organization
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Legal Business Name | NORTHLAND DENTAL PARTNERS, PLLC
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 7430 80TH ST S STE 201
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3041
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Country | US
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Telephone | 651-459-2232
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Fax | 651-768-7748
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Provider Business Mailing Address
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Address Line | 7430 80TH ST S STE 201
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3041
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Country | US
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Telephone | 651-459-2232
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Fax | 651-768-7748
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CELIA HAYES
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Credential |
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Telephone | 217-540-2100
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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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