Provider Demographics
NPI:1043509425
Name:CENTURY COLLEGE DENTAL HYGIENE PROGRAM
Entity Type:Organization
Organization Name:CENTURY COLLEGE DENTAL HYGIENE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:651-779-3983
Mailing Address - Street 1:3300 CENTURY AVE N
Mailing Address - Street 2:EAST CAMPUS - DENTAL CLINIC
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1842
Mailing Address - Country:US
Mailing Address - Phone:651-779-3983
Mailing Address - Fax:651-779-3401
Practice Address - Street 1:3300 CENTURY AVE N
Practice Address - Street 2:EAST CAMPUS - DENTAL CLINIC
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-1842
Practice Address - Country:US
Practice Address - Phone:651-779-3983
Practice Address - Fax:651-779-3401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTURY COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH1557261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental