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General NPI Number Information
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NPI Number | 1578674131
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Entity Type | Organization
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Legal Business Name | OAKDALE FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1399 GENEVA AVE N SUITE 101
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City | OAKDALE
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State | MN
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Zip | 55128-5709
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Country | US
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Telephone | 651-731-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 1399 GENEVA AVE N SUITE 101
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City | OAKDALE
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State | MN
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Zip | 55128-5709
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Country | US
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Telephone | 651-731-6464
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE ALBIN LINDBERG
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Credential | D.D.S.
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Telephone | 651-731-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7994898
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License Number State | MN
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