Provider Demographics
NPI:1952446338
Name:LINDAHL FAMILY DENTAL PA
Entity Type:Organization
Organization Name:LINDAHL FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LINDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-702-4200
Mailing Address - Street 1:1811 WEIR DR
Mailing Address - Street 2:SUITE #265
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2272
Mailing Address - Country:US
Mailing Address - Phone:651-702-4200
Mailing Address - Fax:651-702-0717
Practice Address - Street 1:1811 WEIR DR
Practice Address - Street 2:SUITE #265
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2272
Practice Address - Country:US
Practice Address - Phone:651-702-4200
Practice Address - Fax:651-702-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN707828OtherUNITED CONCORDIA TRICARE
MAZDB012OtherBCBS OF MASS PROVIDER #
MN10D80LIOtherBCBS MN PROVIDER #