Provider Demographics
NPI:1336204536
Name:LORRIS G. VATNSDAL, LTD.
Entity Type:Organization
Organization Name:LORRIS G. VATNSDAL, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:VATNSDAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-463-2100
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-0188
Mailing Address - Country:US
Mailing Address - Phone:218-463-2100
Mailing Address - Fax:218-463-3055
Practice Address - Street 1:205A 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1007
Practice Address - Country:US
Practice Address - Phone:218-463-2100
Practice Address - Fax:218-463-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND89491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty