| Northern Orthodontics | |
|
1109 East Moore Lake Drive Fridley MN 55432 | |
| (651) 439-2600 | |
| (651) 439-2211 |
| Full Name | Northern Orthodontics |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1109 East Moore Lake Drive, Fridley, Minnesota |
| Authorized Official Name and Position | Doug S Wolff (OWNER) |
| Authorized Official Contact | 6514392600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Orthodontics 1109 East Moore Lake Drive Fridley MN 55432 Ph: (651) 439-2600 | Northern Orthodontics 1109 East Moore Lake Drive Fridley MN 55432 Ph: (651) 439-2600 |
| NPI Number | 1659670362 |
|---|---|
| Provider Enumeration Date | 03/21/2011 |
| Last Update Date | 03/21/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659670362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D111236 (Minnesota) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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