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General NPI Number Information
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NPI Number | 1669655890
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Entity Type | Organization
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Legal Business Name | RICHFIELD ORTHODONTIC ASSOCIATES
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1537 E 66TH ST SUITE 100
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City | RICHFIELD
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State | MN
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Zip | 55423-2663
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Country | US
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Telephone | 612-866-3333
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Fax | 612-866-2845
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Provider Business Mailing Address
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Address Line | 1537 E 66TH ST SUITE 100
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City | RICHFIELD
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State | MN
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Zip | 55423-2663
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Country | US
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Telephone | 612-866-3333
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Fax | 612-866-2845
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | WILLIAM F. LILJEMARK
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Credential | DDS
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Telephone | 612-866-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7105
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License Number State | MN
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