NPIMap

Organization Active NPI

Northern Orthodontics

  • Dental Clinic/Center
  • Fridley, MN
National Provider Identifier
1407166317
Registry record updated Oct 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
11236 Issued in MN
Legal business name
NORTHERN ORTHODONTICS
Practice address
1109 Moore Lake Dr E
Fridley, MN 55432-5171
Phone
(651) 351-7777
Fax
(651) 439-2211
NPI assigned
Oct 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Douglas S Wolff
Title
Owner
Phone
(651) 351-7777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 11236 MN Primary

Addresses

Primary practice location

1109 Moore Lake Dr E
Fridley, MN 55432-5171

Mailing address

13961 60TH St N
Stillwater, MN 55082-1053
Phone (651) 351-7777

National Provider Directory

National Provider Directory
Tax ID family
Minneapolis-St Paul Periodontics12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286928000000",
    "number": "1407166317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13961 60TH ST N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550821053",
            "telephone_number": "651-351-7777",
            "fax_number": "651-439-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 MOORE LAKE DR E",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325171",
            "telephone_number": "651-351-7777",
            "fax_number": "651-439-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-13",
        "last_updated": "2010-10-13",
        "status": "A",
        "authorized_official_last_name": "WOLFF",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-351-7777",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "11236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.