Provider Demographics
NPI:1598976326
Name:OAKDALE EAR, NOSE & THROAT CLINIC, P.A.
Entity type:Organization
Organization Name:OAKDALE EAR, NOSE & THROAT CLINIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-233-5775
Mailing Address - Street 1:8301 GOLDEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4475
Mailing Address - Country:US
Mailing Address - Phone:763-233-5755
Mailing Address - Fax:763-233-5782
Practice Address - Street 1:8301 GOLDEN VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4435
Practice Address - Country:US
Practice Address - Phone:763-233-5755
Practice Address - Fax:763-233-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty