NORTHDALE DENTIST PA
Organization (NPI-2)
Active
Dentist, General Practice
Provider Information
- NPI Number
1619287562- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 2147, NORTHDALE BLVD NW., COON RAPIDS, MN, 55433
- Phone
- (763) 497-6977
- Fax
- (763) 463-7807
Specialties & Taxonomies
Dentist, General Practice
Primary License: MN #D12003