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General NPI Number Information
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NPI Number | 1780866962
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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 | 11/29/2007
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 3030 CENTRE POINTE DR SUITE 100
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City | ROSEVILLE
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State | MN
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Zip | 55113-1112
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Country | US
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Telephone | 651-286-8100
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Fax | 651-633-6811
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Provider Business Mailing Address
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Address Line | 3030 CENTRE POINTE DR SUITE 100
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City | ROSEVILLE
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State | MN
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Zip | 55113-1112
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Country | US
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Telephone | 651-286-8100
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Fax | 651-633-6811
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | DR. JAMES LUDKE
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Credential | DDS
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Telephone | 651-286-8100
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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 | D12311
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License Number State | MN
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