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General NPI Number Information
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NPI Number | 1962645051
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Entity Type | Organization
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Legal Business Name | MINNESOTA ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS PA
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1745 N FRONTAGE RD
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City | HASTINGS
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State | MN
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Zip | 55033-3490
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Country | US
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Telephone | 651-450-7273
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Fax |
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Provider Business Mailing Address
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Address Line | 955 HIGHWAY 55
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City | HASTINGS
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State | MN
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Zip | 55033-2365
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Country | US
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Telephone | 651-450-7273
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Fax |
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Authorized Official
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Title or Position | FINANCIAL COORD
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Name | REBECCA CRAIG
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Credential |
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Telephone | 651-750-7273
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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 | 10244
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License Number State | MN
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