Provider Demographics
NPI:1306185160
Name:ARROWHEAD ORTHODONTICS PC
Entity Type:Organization
Organization Name:ARROWHEAD ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-722-4484
Mailing Address - Street 1:3617 W ARROWHEAD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4046
Mailing Address - Country:US
Mailing Address - Phone:218-722-4484
Mailing Address - Fax:218-722-5217
Practice Address - Street 1:3617 W ARROWHEAD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4046
Practice Address - Country:US
Practice Address - Phone:218-722-4484
Practice Address - Fax:218-722-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113451223X0400X
MN124871223X0400X
MN124541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty