Provider Demographics
NPI:1225031156
Name:NORTHVIEW DENTAL, P.A.
Entity Type:Organization
Organization Name:NORTHVIEW DENTAL, P.A.
Other - Org Name:NORTHVIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORSTED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-483-1858
Mailing Address - Street 1:4700 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5844
Mailing Address - Country:US
Mailing Address - Phone:651-483-1858
Mailing Address - Fax:651-766-8400
Practice Address - Street 1:4700 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5844
Practice Address - Country:US
Practice Address - Phone:651-483-1858
Practice Address - Fax:651-766-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty