Provider Demographics
NPI:1780866962
Name:NORTHLAND DENTAL PARTNERS, PLLC
Entity Type:Organization
Organization Name:NORTHLAND DENTAL PARTNERS, PLLC
Other - Org Name:METRO DENTALCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-286-8100
Mailing Address - Street 1:3030 CENTRE POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1112
Mailing Address - Country:US
Mailing Address - Phone:651-286-8100
Mailing Address - Fax:651-633-6811
Practice Address - Street 1:3030 CENTRE POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1112
Practice Address - Country:US
Practice Address - Phone:651-286-8100
Practice Address - Fax:651-633-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty