Provider Demographics
NPI:1013684786
Name:NORTHWEST DENTAL GROUP
Entity Type:Organization
Organization Name:NORTHWEST DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:POST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-289-3921
Mailing Address - Street 1:2510 SUPERIOR DR NW STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8349
Mailing Address - Country:US
Mailing Address - Phone:507-289-2020
Mailing Address - Fax:507-424-2943
Practice Address - Street 1:822 38TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6985
Practice Address - Country:US
Practice Address - Phone:507-289-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty