| Northland Endodontics Pa | |
|
11800 Aberdeen St Ne Suite 140 Blaine MN 55449-4808 | |
| (763) 772-0330 | |
| (763) 772-0354 |
| Full Name | Northland Endodontics Pa |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 11800 Aberdeen St Ne, Blaine, Minnesota |
| Authorized Official Name and Position | Kris David Johnson (PRESIDENT) |
| Authorized Official Contact | 7637720330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northland Endodontics Pa 11800 Aberdeen St Ne Suite 140 Blaine MN 55449-4808 Ph: (763) 772-0330 | Northland Endodontics Pa 11800 Aberdeen St Ne Suite 140 Blaine MN 55449-4808 Ph: (763) 772-0330 |
| NPI Number | 1932200037 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932200037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | D10585 (Minnesota) | Primary |
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