Provider Demographics
NPI:1417044793
Name:DEAN C. LINDQUIST, D.D.S.
Entity type:Organization
Organization Name:DEAN C. LINDQUIST, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:LINDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-329-8321
Mailing Address - Street 1:107 DUPONT AVE NW
Mailing Address - Street 2:P.O. BOX 588
Mailing Address - City:RENVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56284-0588
Mailing Address - Country:US
Mailing Address - Phone:320-329-8321
Mailing Address - Fax:320-329-8322
Practice Address - Street 1:107 NW DUPONT AVE
Practice Address - Street 2:
Practice Address - City:RENVILLE
Practice Address - State:MN
Practice Address - Zip Code:56284-0588
Practice Address - Country:US
Practice Address - Phone:320-329-8321
Practice Address - Fax:320-329-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty