Provider Demographics
NPI:1376785501
Name:CENTRAL MINNESOTA ENDODONTICS, PA
Entity Type:Organization
Organization Name:CENTRAL MINNESOTA ENDODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WURM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-656-1456
Mailing Address - Street 1:1900 KRUCHTEN CT S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4730
Mailing Address - Country:US
Mailing Address - Phone:320-656-1456
Mailing Address - Fax:320-656-0195
Practice Address - Street 1:1900 KRUCHTEN CT S
Practice Address - Street 2:SUITE 100
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4730
Practice Address - Country:US
Practice Address - Phone:320-656-1456
Practice Address - Fax:320-656-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110351223E0200X
MN117901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty