Jeffrey Nelson Holmberg, DDS
Individual provider Active NPI General Practice Dentistry · Annandale, MN
NPI 1811051436 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811051436
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 8955 (MN)
- Practice address
- 300 Park Street East
Annandale, MN 55302-0370 - Phone
- (320) 274-8555
- Fax
- (320) 274-2851
- NPI assigned
- Dec 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| I20150623000562 | MN | Order and Referring Only - Oral Surgery |
4981915691 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8955 | MN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8955 | MN | Yes |
Addresses
Primary practice location
300 Park Street East
Annandale, MN 55302-0370
Mailing address
300 Park Street East
PO Box 370
Annandale, MN 55302-0370
Phone (320) 274-8555
Other providers in Annandale, MN
- Anthony David Hegge
- Eric Richard Heimkes
- Dawn Mae Hill
- Myka Fawn Hirschey
- Amanda Hoffman
- Cynthia Ann Jensen
- Craig Steven Johnson
- Mark Steven Johnson
- Matthew Johnson
- Katherine Marie Kalliomaa
All providers in Annandale, 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 8, 2007. 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.