Provider Demographics
NPI:1336575539
Name:SCOTT L BJERKE DDS PA
Entity Type:Organization
Organization Name:SCOTT L BJERKE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-452-3112
Mailing Address - Street 1:2130 CLIFF RD
Mailing Address - Street 2:SIUTE 107
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2485
Mailing Address - Country:US
Mailing Address - Phone:651-452-3112
Mailing Address - Fax:651-688-0487
Practice Address - Street 1:2130 CLIFF RD
Practice Address - Street 2:SIUTE 107
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2485
Practice Address - Country:US
Practice Address - Phone:651-452-3112
Practice Address - Fax:651-688-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty