Provider Demographics
NPI:1609090711
Name:NORWOOD DENTAL
Entity Type:Organization
Organization Name:NORWOOD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-467-3518
Mailing Address - Street 1:P.O. BOX 717
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55368-0717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 E. WILSON STREET
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MN
Practice Address - Zip Code:55368-0717
Practice Address - Country:US
Practice Address - Phone:952-467-3518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty