Provider Demographics
NPI:1700104072
Name:STEIDL FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:STEIDL FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEIDL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-236-9319
Mailing Address - Street 1:915 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6148
Mailing Address - Country:US
Mailing Address - Phone:218-236-9319
Mailing Address - Fax:
Practice Address - Street 1:915 37TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-236-9319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12067261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental