Provider Demographics
NPI:1841991262
Name:SODERHOLM ORAL SURGERY AND IMPLANTS
Entity type:Organization
Organization Name:SODERHOLM ORAL SURGERY AND IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SODERHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-298-1000
Mailing Address - Street 1:120 12TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2528
Mailing Address - Country:US
Mailing Address - Phone:320-298-1000
Mailing Address - Fax:320-227-3423
Practice Address - Street 1:120 12TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2528
Practice Address - Country:US
Practice Address - Phone:320-298-1000
Practice Address - Fax:320-227-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty