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Organization
JOHN D. NYDAHL, DDS, P. A.
Active
Organization
JOHN D. NYDAHL, DDS, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D. NYDAHL DDS (PRESIDENT)
(320) 253-0744
Entity
Organization
Contact information
Practice address
1011 2ND ST N STE 101, SAINT CLOUD, MN 56303-3237
(320) 253-0744
(320) 253-9930
Mailing address
1011 2ND ST N STE 101, SAINT CLOUD, MN 56303-3237
(320) 253-0744
(320) 253-9930
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D8204
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55162NY
BLUE CROSS BLUE SHIELD
MN
01
—
D8204
DELTA DENTAL
MN
Enumeration date
07/27/2006
Last updated
08/22/2020
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