Provider Demographics
NPI:1326191917
Name:LINDQUIST, ROLF E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLF
Middle Name:E
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0670
Mailing Address - Country:US
Mailing Address - Phone:218-387-2774
Mailing Address - Fax:
Practice Address - Street 1:303 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-0670
Practice Address - Country:US
Practice Address - Phone:218-387-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN87491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN373318100Medicaid