# NORTHSTAR ORTHODONTICS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669828539
- **Authorized official:** MRS. CYNTHIA J. KELLY (CEO/CFO)
- **Authorized official phone:** (218) 732-9503

## Contact information

- **Practice address:** 218 INDUSTRIAL PARK RD, PARK RAPIDS, MN 56470-3508
- **Practice address phone:** (218) 732-9503
- **Mailing address:** 218 INDUSTRIAL PARK RD, PARK RAPIDS, MN 56470-3508
- **Mailing address phone:** (218) 732-9503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | DL109 | MN | Yes |

## Other

- **Enumeration date:** 05/10/2016
- **Last updated:** 05/10/2016