Provider Demographics
NPI:1922109800
Name:MESABI DENTAL SERVICE
Entity Type:Organization
Organization Name:MESABI DENTAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRITTINEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-749-8908
Mailing Address - Street 1:216 N 5TH AV
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792
Mailing Address - Country:US
Mailing Address - Phone:218-749-8908
Mailing Address - Fax:218-749-8909
Practice Address - Street 1:216 N 5TH AV
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792
Practice Address - Country:US
Practice Address - Phone:218-749-8908
Practice Address - Fax:218-749-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty