Michael A Hursh, DDS
Individual provider Active NPI General Practice Dentistry · Lindstrom, MN
NPI 1629079983 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1629079983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 8021 (MN)
- Practice address
- 30554 Park St
Lindstrom, MN 55045 - Phone
- (651) 257-4471
- Fax
- (651) 257-2017
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160105001271 | MN | Order and Referring Only - Dentist |
4284936451 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8021 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lindstrom Family Dentistry LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8021 | MN | Yes |
Addresses
Primary practice location
30554 Park St
Lindstrom, MN 55045
Mailing address
PO Box 705
Lindstrom, MN 55045-0705
Phone (651) 257-4471
Other providers in Lindstrom, MN
- Sean Patrick Goolsby
- Eric Jon Gormanson
- Shawna Jo Griffin
- Kelly Marie Helland
- Regina Hollibush
- Virginia Johnson
- Kimberley M Johnson DC
- Varghese Daniel Kottarathil
- Lake and Leaf Chiropractic PLLC
- Lake Optometric Vision PA
All providers in Lindstrom, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.