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General NPI Number Information
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NPI Number | 1700104072
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Entity Type | Organization
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Legal Business Name | STEIDL FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 915 37TH AVE S
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City | MOORHEAD
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State | MN
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Zip | 56560
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Country | US
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Telephone | 218-236-9319
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Fax |
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Provider Business Mailing Address
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Address Line | 915 37TH AVE S
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City | MOORHEAD
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State | MN
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Zip | 56560-6148
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Country | US
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Telephone | 218-236-9319
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMIE W STEIDL
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Credential | DDS
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Telephone | 218-236-9319
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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 | D12067
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License Number State | MN
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