Provider Demographics
NPI:1003948217
Name:DRS CATTON WOLSETH COMO & JACOBSON PA
Entity Type:Organization
Organization Name:DRS CATTON WOLSETH COMO & JACOBSON PA
Other - Org Name:NORTHWAY DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:COMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-253-7700
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:1500 NORTHWAY DRIVE
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-1659
Mailing Address - Country:US
Mailing Address - Phone:320-253-7700
Mailing Address - Fax:320-253-9271
Practice Address - Street 1:1500 NORTHWAY DRIVE
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-253-7700
Practice Address - Fax:320-253-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8011122300000X
MN9182122300000X
MN9096122300000X
MN11952122300000X
MN11953122300000X
MN9874122300000X
MN8837122300000X
MN10445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty