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NPI Code Detail

MEDICARE: NORTHLAND DENTAL PARTNERS PLLC

MEDICARE: NORTHLAND DENTAL PARTNERS PLLC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1881841021
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHLAND DENTAL PARTNERS PLLC
Provider Business Mailing Address
First Line : 3030 CENTRE POINTE DR
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1112
Country : US
Telephone Number : 651-286-8100
Fax Number :
Provider Business Practice Location Address
First Line : 4670 PARK NICOLLET AVE SE
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-4119
Country : US
Telephone Number : 952-447-7606
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JAMES LUDKE
Credential : DDS
Telephone Number : 651-286-8100
Provider Enumeration Date : 08/19/2008
Last Update Date : 08/19/2008

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Directions to “NORTHLAND DENTAL PARTNERS PLLC ” Practice Location

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