Provider Demographics
NPI:1316105083
Name:NORTHWEST DENTAL GROUP OF ROCHESTER
Entity type:Organization
Organization Name:NORTHWEST DENTAL GROUP OF ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:POST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-272-2020
Mailing Address - Street 1:2510 SUPERIOR DR. SUITE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901
Mailing Address - Country:US
Mailing Address - Phone:507-289-3921
Mailing Address - Fax:
Practice Address - Street 1:111 FRONTAGE RD NE
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920
Practice Address - Country:US
Practice Address - Phone:507-289-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental