Provider Demographics
NPI:1598202319
Name:WHITE BIRCH DENTAL, PLLC
Entity type:Organization
Organization Name:WHITE BIRCH DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-389-1373
Mailing Address - Street 1:510 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1604
Mailing Address - Country:US
Mailing Address - Phone:763-389-1373
Mailing Address - Fax:763-389-0538
Practice Address - Street 1:510 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1604
Practice Address - Country:US
Practice Address - Phone:763-389-1373
Practice Address - Fax:763-389-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND132431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty