MEDICARE: DR. KATHERINE ANNE NORDEEN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D12843	MN
2	1223P0221X	Pediatric Dentistry	D12843	MN

General Provider Information

NPI Number	:	1558672733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE ANNE NORDEEN D.D.S.

Provider Business Mailing Address
First Line	:	15160 FOLIAGE AVE STE 110
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-5903
Country	:	US
Telephone Number	:	527-156-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	15160 FOLIAGE AVE STE 110
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-5903
Country	:	US
Telephone Number	:	952-715-6177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	03/17/2025

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