Provider Demographics
NPI:1952997421
Name:NODLANDMONDRY, P.L.L.C.
Entity Type:Organization
Organization Name:NODLANDMONDRY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MONDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-560-8346
Mailing Address - Street 1:4212 MAVELLE DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4128
Mailing Address - Country:US
Mailing Address - Phone:402-560-8346
Mailing Address - Fax:
Practice Address - Street 1:11800 ABERDEEN ST NE STE 110
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4812
Practice Address - Country:US
Practice Address - Phone:402-560-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty