Organization · Type 2 NPI

Mississippi Headwaters Area Dental Health Center, Inc.

Dental Clinic/Center · Bagley, MN

NPI number 1225811102 Active

Practice location

13 Main Ave N
Bagley, MN 56621-8315

Call (218) 694-6571 Map

Mailing address

1405 Anne St NW
Bemidji, MN 56601-5113

Specialties and licenses

Taxonomy	Code	License
Dental Clinic/Center Primary	261QD0000X	None listed

Dental Clinic/Center: Definition to come...

Another provider at this address

Bagley DentalDentist Bagley, MN NPI 1407030984

NPI record

NPI: 1225811102
Entity type: Organization (Type 2)
Issued: Aug 15, 2023
Last updated: Aug 15, 2023
Status: Active
Subpart: Yes of Mississippi Headwaters Area Dental Health Center

Other names

Northern Dental Access Center · doing business as

Authorized official

Erica Anne Lundberg, MBA
Director of Finance and Operations
(218) 444-9147

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1225811102

Mississippi Headwaters Area Dental Health Center, Inc.'s National Provider Identifier is 1225811102, issued on Aug 15, 2023. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Bagley, MN. The record was last updated on Aug 15, 2023.