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General NPI Number Information
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NPI Number | 1598976326
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Entity Type | Organization
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Legal Business Name | OAKDALE EAR, NOSE & THROAT CLINIC, P.A.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 8301 GOLDEN VALLEY RD STE 200
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4435
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Country | US
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Telephone | 763-233-5755
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Fax | 763-233-5782
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Provider Business Mailing Address
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Address Line | 8301 GOLDEN VALLEY RD STE 200
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4475
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Country | US
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Telephone | 763-233-5755
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Fax | 763-233-5782
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MARYA C LYDEEN
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Credential |
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Telephone | 763-233-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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