Provider Demographics
NPI:1841463072
Name:NORTHERN LIGHTS FAMILY DENTISTRY,PC
Entity type:Organization
Organization Name:NORTHERN LIGHTS FAMILY DENTISTRY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:DROST-SANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-386-2889
Mailing Address - Street 1:603 EMILY AVE. NW
Mailing Address - Street 2:
Mailing Address - City:WARROAD
Mailing Address - State:MN
Mailing Address - Zip Code:56763
Mailing Address - Country:US
Mailing Address - Phone:218-386-2889
Mailing Address - Fax:
Practice Address - Street 1:603 EMILY AVE. NW
Practice Address - Street 2:
Practice Address - City:WARROAD
Practice Address - State:MN
Practice Address - Zip Code:56763
Practice Address - Country:US
Practice Address - Phone:218-386-2889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11132261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental